Cryoanalgesia in Patients Undergoing Surgical Stabilization of Rib Fractures: A Comparative Study

Effective pain management is crucial to reduce complications and enhance recovery in patients with multiple rib fractures. Although intercostal cryoanalgesia is emerging as a promising strategy to optimize conventional multimodal analgesia in these patients, the literature remains sparse. Since 2019, we have been using cryoanalgesia in surgical stabilization of rib fractures (SSRF), and we hypothesize that it is associated with lower opioid requirements. Thus, we decided to perform a comparative study between patients undergoing SSRF with and without cryoanalgesia.

This retrospective study comprised patients with multiple traumatic rib fractures, who underwent SSRF with multimodal analgesia without cryo (group A) compared with a cohort of similar patients managed with multimodal analgesia with cryo (group B). Multimodal analgesia comprised epidural analgesia, opioids, and nonsteroidal anti-inflammatory drugs. Demographics, severity of pain using the visual analog scale, and median requirement of morphine equivalent dose (MED) were analyzed in both groups. Factors associated with postoperative opioid use were evaluated using descriptive and multivariable analyses.

Thirty-six patients were studied, 9 in group A and 27 in group B. Both groups were similar in age, number of rib fracture fixations required, preoperative requirement of opioids, and length of stay. Regarding postoperative opioid consumption, group A required more than twice MED than group B [37.2 mg (interquartile range [IQR] 28.7-47) versus 14.7 mg (IQR 8.25-19.1); P < 0.001]. This difference increased in the outpatient setting [group A: 18.8 mg (IQR 15-27) versus group B: 0.0 mg (IQR 0-3.45); P < 0.001]. The comparison between visual analog scale at discharge also showed significant differences at 7, 14, and 30 d (P < 0.0001) in both groups. In multivariable analysis, only preoperative MED and cryoanalgesia was independently associated with postoperative opioid requirements (R² = 0.58), with cryoanalgesia associated with a mean reduction of 19.9 MED units (95% confidence interval, -28.0 to -11.0).

Percutaneous intercostal cryoanalgesia was associated with reduced postoperative and outpatient opioid use and improved pain control in patients undergoing surgical stabilization of rib fractures, supporting its potential role as an adjunct to multimodal analgesia.