Comparison of Multimodal Pain Control Following Bilateral Lung Transplantation

Area of Science:

• Thoracic Surgery
• Pain Management
• Anesthesiology

Background:

• Opioid administration is standard post-bilateral lung transplantation (BLTx).
• Opioids carry risks including adverse side effects and potential for opioid use disorder.
• Novel pain management strategies are needed to improve outcomes after BLTx.

Purpose of the Study:

• To compare intercostal cryoablation, liposomal bupivacaine (LipoB), and standard therapy for pain control after BLTx.
• To evaluate the impact of these interventions on opioid administration and clinical outcomes.
• To identify optimal pain management strategies for BLTx patients.

Main Methods:

• Retrospective review of 153 BLTx patients from January 2016 to December 2023.
• Interventions included intraoperative cryoablation, liposomal bupivacaine, or systemic therapy alone.
• Primary outcomes: patient-reported pain and opioid administration (morphine milligram equivalents).

Main Results:

• Cryoablation group reported significantly lower pain through postoperative day 14 (P < .0001).
• No significant difference in overall opioid administration between groups (P = .107).
• Cryoablation was associated with lower rates of postoperative ileus (P = .004) but longer ICU/postoperative length of stay (P < .001).

Conclusions:

• Intercostal cryoablation offers significant pain reduction following BLTx.
• Longer length of stay in the cryoablation group necessitates further investigation.
• Prospective, randomized trials are warranted to confirm these findings and optimize pain management protocols.