Intercostal Cryo Nerve Block in Minimally Invasive Cardiac Surgery: The Prospective Randomized FROST Trial.

Area of Science:

• Cardiothoracic Surgery
• Pain Management
• Pulmonary Function

Background:

• Intercostal cryo nerve block (CryoNB) improves outcomes in post-thoracotomy procedures.
• Its efficacy in minimal invasive heart valve surgery (Mini-HVS) remains unproven.

Purpose of the Study:

• To evaluate if intraoperative CryoNB enhances analgesic efficacy in Mini-HVS patients compared to standard of care (SOC).

Main Methods:

• Prospective, 3:1 randomized multicenter trial (FROST) comparing CryoNB to SOC in Mini-HVS.
• Primary endpoint: 48-hour postoperative forced expiratory volume in 1 second (FEV1).
• Secondary endpoints: pain scores (VAS), length of stay, opioid consumption, and allodynia.

Main Results:

• CryoNB group showed significantly higher 48-hour postoperative FEV1 (1.20 L vs. 0.93 L, P=0.02).
• No significant difference in surgical site pain scores.
• SOC group had 13% higher opioid consumption; lower non-surgical site pain at 72-120h.

Conclusions:

• Intraoperative intercostal cryo nerve block enhances postoperative FEV1 in Mini-HVS.
• CryoNB demonstrated optimized analgesic effectiveness and potential opioid-sparing effects.
• Larger trials are needed to confirm opioid-sparing benefits.