Journal article
A Randomized Study of Cryoablation of Intercostal Nerves in Patients Undergoing Minimally Invasive Thoracic Surgery
The Journal of thoracic and cardiovascular surgery, v 169(5)
08 Nov 2024
PMID: 39522714
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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 cryo-ablation 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 cryo-analgesia group also had 5-6 intercostal nerves ablated. The primary outcome was the amount of narcotics (in morphine mg equivalent, MME) taken during the postoperative hospital stay and the first two weeks post-discharge. Secondary outcomes were incentive spirometry (IS) volume and pain scores in the hospital and pain and neuropathy scores at two weeks.
Our final cohort contained 103 patients (52 standard-of-care; 51 cryo-analgesia). There were no differences between the treatment groups in MMEs administered during the hospital stay (44.9 mg standard of care vs. 38.4 mg cryo-analgesia), total MME at two weeks (108.8 vs. 95.2 mg), or pain assessed on postoperative day (POD) 1 (3.8 and 3.3), POD2 (2 and 3.5), or two weeks (2 and 3.5). The decrease in IS in the postoperative period was not significantly different between the two groups. Patients in the cryo-analgesia group had higher neuropathy scores (8 vs. 13, p=0.019) two weeks after surgery.
In this randomized study, cryo-analgesia did not decrease postoperative pain or narcotic requirements. Cryo-analgesia increased neuropathic pain two weeks after surgery.
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Details
- Title
- A Randomized Study of Cryoablation of Intercostal Nerves in Patients Undergoing Minimally Invasive Thoracic Surgery
- Creators
- Benny Weksler - Allegheny Health NetworkConor Maxwell - Allegheny Health NetworkLauren Drake - Allegheny Health NetworkLawrence Crist - Allegheny Health NetworkKara SpechtPamela Kuchta - Allegheny Health NetworkKurt DeHavenIsabella Weksler - Allegheny Health NetworkBrent A. Williams - Allegheny Health NetworkHiran C. Fernando - Allegheny Health Network
- Publication Details
- The Journal of thoracic and cardiovascular surgery, v 169(5)
- Publisher
- Elsevier; NEW YORK
- Number of pages
- 9
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Medicine (Graduate); Surgery
- Web of Science ID
- WOS:001481851500001
- Scopus ID
- 2-s2.0-85212310350
- Other Identifier
- 991021960806904721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Respiratory System
- Surgery