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Early Percutaneous Cryoneurolysis for Pain Control After Rib Fracture for Older Patients: A Prospective Randomized
Joseph D Forrester1, Anisha Abreo1, Michelle Earley1
1From the Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA (Forrester, Abreo, Earley, King).
Journal of the American College of Surgeons
|February 17, 2026
Summary
Adding CT-guided percutaneous cryoneurolysis (CT-PCN) to standard care did not reduce pain for older adults with rib fractures. In fact, CT-PCN was linked to worse pain scores and quality of life one month post-discharge.
Area of Science:
- Pain Management
- Interventional Radiology
- Geriatric Medicine
Background:
- Rib fractures are common injuries requiring effective pain management.
- Multimodal pain control is crucial, especially for older adults where minimizing side effects is key.
Purpose of the Study:
- To evaluate if CT-guided percutaneous cryoneurolysis (CT-PCN) added to existing pain management bundles improves pain control for elderly patients with rib fractures.
Main Methods:
- A randomized clinical trial compared CT-PCN plus standard care (SoC) versus SoC alone in adults aged 65+ with rib fractures.
- The primary outcome was pain score at deep inspiration within 24 hours of discharge.
- Secondary outcomes included hospital stay, readmissions, adverse events, opioid use, and quality of life scores (SF-12, McGill).
Main Results:
- No significant difference in pain scores at discharge was observed between the CT-PCN and SoC groups.
- Opioid use (MME) on the day of discharge was also similar between groups.
- At one month, patients receiving CT-PCN reported worse numeric pain scores (P=0.04) and sensory pain scores (P<0.001).
Conclusions:
- CT-guided percutaneous cryoneurolysis did not effectively reduce pain in older adults with rib fractures when added to multimodal care.
- The intervention may be associated with poorer physical quality and emotional response to pain post-discharge.
