A randomized study of cryoablation of intercostal nerves in patients undergoing minimally invasive thoracic surgery

Minimally invasive thoracic surgery can cause significant pain, and optimizing pain control after surgery is highly desirable. We examined pain control after intercostal nerve block with or without cryoablation of the intercostal nerves.

This was a randomized study (NCT05348447) of adults scheduled for a minimally invasive thoracic procedure. Each intercostal space near the incision site was injected with lidocaine and bupivacaine with epinephrine (standard of care). The cryoanalgesia group also had 5 to 6 intercostal nerves ablated. The primary outcome was the amount of narcotics (in morphine milligram equivalents taken during the postoperative hospital stay and the first 2 weeks postdischarge. Secondary outcomes were incentive spirometry volume and pain scores in the hospital and pain and neuropathy scores at 2 weeks.

Our final cohort contained 103 patients (52 standard of care and 51 cryoanalgesia). There were no differences between the treatment groups in morphine milligram equivalents administered during the hospital stay (44.9 vs 38.4 mg), total morphine milligram equivalents at 2 weeks (108.8 vs 95.2 mg), or pain assessed by visual analog scale on postoperative day 1 (3.8 and 3.3), postoperative day 2 (2 and 3.5), or 2 weeks (2 and 3.5) for standard of care and cryoanalgesia group patients, respectively. The decrease in incentive spirometry during the postoperative period was not significantly different between the 2 groups. Patients in the cryoanalgesia group had higher neuropathy scores (8 vs 13; P = .019) 2 weeks after surgery.

In this randomized study, cryoanalgesia did not decrease postoperative pain or narcotic requirements. Cryoanalgesia increased neuropathic pain 2 weeks after surgery.