A Randomized Study of Cryoablation of Intercostal Nerves in Patients Undergoing Minimally Invasive Thoracic Surgery

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.