Intercostal nerve cryoablation during surgical stabilization of rib fractures decreases post-operative opioid use, ventilation days, and intensive care days

Matthew N Marturano; Vandan Thakkar; Huaping Wang; Kyle W Cunningham; Cynthia Lauer; Gaurav Sachdev; Samuel W Ross; Mary M Jordan; Sean T Dieffenbaugher; Ronald F Sing; Bradley W Thomas

doi:10.1016/j.injury.2023.05.034

Intercostal nerve cryoablation during surgical stabilization of rib fractures decreases post-operative opioid use, ventilation days, and intensive care days

Injury. 2023 Sep;54(9):110803. doi: 10.1016/j.injury.2023.05.034. Epub 2023 May 11.

Affiliations

¹ Department of Trauma and Acute Care Surgery, Atrium Health-Carolinas Medical Center, Charlotte NC, USA.
² Campbell University School of Osteopathic Medicine, Lillington NC, USA.
³ Department of Trauma and Acute Care Surgery, Atrium Health Cabarrus, Concord NC, USA.
⁴ Department of Trauma and Acute Care Surgery, Atrium Health-Carolinas Medical Center, Charlotte NC, USA. Electronic address: Bradley.Thomas@atriumhealth.org.

PMID: 37193637
DOI: 10.1016/j.injury.2023.05.034

Abstract

Background: Intercostal nerve cryoablation is an adjunctive measure that has demonstrated pain control, decrease in opioid consumption, and decrease in hospital length of stay (LOS) in patients who undergo surgical stabilization of rib fractures (SSRF).

Methods: SSRF patients from January 2015 to September 2021 were retrospectively compared. All patients received multimodal pain regimens post-operatively and the independent variable was intraoperative cryoablation.

Results: 241 patients met inclusion criteria. 51 (21%) underwent intra-operative cryoablation during SSRF and 191 (79%) did not. Patients with standard treatment consumed 9.4 more daily MME (p = 0.035), consumed 73 percent more post-operative total MME (p = 0.001), spent 1.55 times as many days in the intensive care unit (p = 0.013), and spent 3.8 times as many days on the ventilator than patients treated with cryoablation, respectively. Overall hospital LOS, operative case time, pulmonary complications, MME at discharge, and numeric pain scores at discharge were no different (all p>0.05).

Conclusion: Intercostal nerve cryoablation during SSRF is associated with fewer ventilator days, ICU LOS, total post-operative, and daily opioid use without increasing time in the operating room or perioperative pulmonary complications.

Keywords: Cryoablation; Morbidity; Opioid; Pain; Rib fractures; Trauma.