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. 2023 Feb;12(1):201-211.
doi: 10.1007/s40122-022-00448-z. Epub 2022 Oct 23.

Intercostal Nerve Cryoanalgesia Versus Thoracic Epidural Analgesia in Lung Transplantation: A Retrospective Single-Center Study

Erin Isaza #  1 , Jesse Santos #  2 , Greg J Haro  3 , Joy Chen  3 , Daniel J Weber  3 , Tobias Deuse  3 , Jonathan P Singer  4 , Jeffrey A Golden  4 , Steven Hays  4 , Binh N Trinh  3 , Marek Brzezinski  5 , Jasleen Kukreja  6
Affiliations

Intercostal Nerve Cryoanalgesia Versus Thoracic Epidural Analgesia in Lung Transplantation: A Retrospective Single-Center Study

Erin Isaza et al. Pain Ther. 2023 Feb.

Abstract

Introduction: The optimal pain management strategy after lung transplantation is unknown. This study compared analgesic outcomes of intercostal nerve blockade by cryoanalgesia (Cryo) versus thoracic epidural analgesia (TEA).

Methods: Seventy-two patients who underwent bilateral lung transplantation via clamshell incision at our center from 2016 to 2018 were managed with TEA (N = 43) or Cryo (N = 29). We evaluated analgesic-specific complications, opioid use in oral morphine equivalents (OME), and pain scores (0-10) through postoperative day 7. Adjusted linear regression was used to assess for non-inferiority of Cryo to TEA.

Results: The overall mean pain scores (Cryo 3.2 vs TEA 3.8, P = 0.21), maximum mean pain scores (Cryo 4.7 vs TEA 5.5, P = 0.16), and the total opioid use (Cryo 484 vs TEA 705 OME, P = 0.12) were similar in both groups, while the utilization of postoperative opioid-sparing analgesia, measured as use of lidocaine patches, was lower in the Cryo group (Cryo 21% vs TEA 84%, P < 0.001). Analgesic outcomes remained similar between the cohorts after adjustment for pertinent patient and analgesic characteristics (P = 0.26), as well as after exclusion of Cryo patients requiring rescue TEA (P = 0.32). There were no Cryo complications, with four patients requiring subsequent TEA for pain control. Two TEA patients experienced hemodynamic instability following a test TEA bolus requiring code measures. Additionally, TEA placement was delayed beyond postoperative day 1 in 33% owing to need for anticoagulation or clinical instability.

Conclusions: In lung transplantation, Cryo was found to be safe with analgesic effectiveness similar to TEA. Cryo may be advantageous in this complex patient population, as it can be used in all clinical scenarios and eliminates risks and delays associated with TEA.

Keywords: Bilateral thoracotomy; Cryoablation; Lung transplantation; Pain management; Thoracic epidural analgesia.

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Figures

Fig. 1
Fig. 1
Outline of study design, including exclusion criteria. All patients receiving any Cryo were analyzed as part of the Cryo cohort
Fig. 2
Fig. 2
a Intercostal nerve blockade by cryoprobe for lung transplant clamshell incision. b Packaged CryoSphere. c CryoICE box setup
Fig. 3
Fig. 3
Daily pain scores (0–10). Following clamshell incision for lung transplantation, cryoanalgesia (Cryo) or thoracic epidural analgesia (TEA) was utilized for pain management. In unadjusted analysis depicted in these figures, pain was overall well controlled. a Average pain score. Cryo and TEA had similar average pain scores through postoperative day 7 (POD7). b Maximum pain score. Maximum pain scores through POD7 were also similar between the cohorts. Data represent mean with standard deviation
Fig. 4
Fig. 4
Daily opioid use. Following clamshell incision for lung transplantation, cryoanalgesia (Cryo) or thoracic epidural analgesia (TEA) was utilized for pain management. In unadjusted analysis depicted in this figure, Cryo patients appeared to utilize fewer opioids through postoperative day 7 (POD7), and the difference in opioid use between cohorts appeared to increase over time. Data represent mean with standard deviation
See this image and copyright information in PMC

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