Non-Pharmacological Option in Postoperative Pain: Pilot Study of Intraoperative Pulsed Radiofrequency

Postoperative pain remains a discomfort for patients undergoing thoracic surgery despite advances in minimally invasive techniques. Pulsed radiofrequency (PRF) is a minimally invasive neuromodulation method used for chronic pain. This pilot study aimed to evaluate the efficacy of intraoperative PRF (iPRF) as an adjunct to conventional analgesia (thoracic epidural analgesia [TEA] or intercostal nerve block [INB]) in alleviating postoperative pain and analgesic use following minimally invasive thoracic surgery.

A prospective pilot cohort was compared with historical controls at a single tertiary hospital in Japan. The iPRF group (n = 30) received PRF targeting the intercostal nerves intraoperatively in addition to standard analgesia. The control group comprised retrospective patients who received standard analgesia alone. Patients were stratified into TEA and INB subgroups according to procedure type. The primary end-point was the proportion of patients requiring additional analgesics. Secondary end-points included pain scores (numerical rating scale [NRS]), incidence of intercostal neuralgia, and side effects.

Intraoperative PRF significantly reduced the need for additional analgesics in TEA (26.7% vs 60.0%, P = .027) and INB (6.7% vs 42.1, P = .020) subgroups. In the TEA group, iPRF also reduced the proportion of patients reporting NRS ≥4 following drain removal (26.7% vs 60.0%, P = .027). The incidence of analgesic-induced side effects was significantly lower in the iPRF INB group (0% vs 28.6%, P = .031). No adverse events were associated with iPRF.

Intraoperative PRF may be a safe and effective adjunctive method for postoperative pain alleviation in thoracic surgery, reducing analgesic requirements.

The Institutional Review Board of St. Luke's International Hospital approved the study (No. 24-R085) on September 9, 2024.