Intercostal cryoanalgesia for acute pain after video-assisted thoracic surgery lung resection: A randomized controlled preliminary trial

Abstract

Objective: Video-assisted thoracoscopic surgery (VATS) is associated with significant postoperative pain. Multimodal analgesia, including single-shot paravertebral blocks, is widely used but provides limited analgesic duration. Intercostal cryoanalgesia, which offers prolonged pain relief, presents a promising adjunctive option. This study aimed to assess the analgesic benefit of intercostal cryoanalgesia in VATS lung cancer surgery. The primary outcome was thoracic pain during cough 24 hours postsurgery, measured via a verbal numerical rating scale.

Methods: In a randomized, double-blind, controlled trial, 80 patients undergoing VATS lobectomy for lung cancer were assigned to either a control group receiving standard multimodal analgesia with single-shot paravertebral blocks or a cryoanalgesia group receiving additional transpleural intercostal cryoanalgesia (Cryoprobe; Erbe). Thoracic pain at rest and during cough was evaluated at multiple time points up to 6 months postoperatively. Secondary outcomes included quality of recovery, oral morphine equivalents consumption, side effects, thoracic sensory loss (Von Frey filament), and neuropathic pain (Douleur neuropathique 4 score).

Results: Thoracic verbal numerical rating scale during cough at 24 hours showed no significant difference between groups (4.7 ± 2.7 vs 4.8 ± 2.9; P = .78). Pain scores, quality of recovery, opioid consumption, side effects, Douleur neuropathique 4 scores, and sensory loss incidence were comparable over 7 days. Pain scores during cough were significantly higher 1 month after surgery (4.7 ± 2.4 vs 3.4 ± 2.0; P = .036) but not at 3-month and 6-month follow-up.

Conclusions: In this double-blind trial, measurable cryoanalgesia was not observed in the treatment group during cough at 24 hours post-VATS, nor was measurable thoracic sensory loss or improved acute or chronic recovery outcomes.

Keywords: cryoanalgesia; pain; thoracic surgery; video-assisted thoracoscopic surgery.