Efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain after surgery or trauma: systematic review

Abstract

BackgroundThere is a critical need for non-narcotic analgesic adjuncts in the treatment of thoracic pain. We evaluated the efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain, specifically addressing the applicability of intercostal cryoneurolysis for pain control after chest wall trauma.MethodsA systematic review was performed through searches of PubMed, EMBASE, and the Cochrane Library. We included studies involving patients of all ages that evaluated the efficacy of intercostal cryoneurolysis as a pain adjunct for chest wall pathology. Quantitative and qualitative synthesis was performed.ResultsTwenty-three studies including 570 patients undergoing cryoneurolysis met eligibility criteria for quantitative analysis. Five subgroups of patients treated with intercostal cryoneurolysis were identified: pectus excavatum (nine studies); thoracotomy (eight studies); post-thoracotomy pain syndrome (three studies); malignant chest wall pain (two studies); and traumatic rib fractures (one study). There is overall low-quality evidence supporting intercostal cryoneurolysis as an analgesic adjunct for chest wall pain. A majority of studies demonstrated decreased inpatient narcotic use with intercostal cryoneurolysis compared with conventional pain modalities. Intercostal cryoneurolysis may also lead to decreased hospital length of stay. The procedure did not definitively increase operative time, and risk of complications was low.ConclusionsGiven the favorable risk-to-benefit profile, both percutaneous and thoracoscopic intercostal cryoneurolysis may serve as a worthwhile analgesic adjunct in trauma patients with rib fractures who have failed conventional medical management. However, further prospective studies are needed to improve quality of evidence.Level of evidenceLevel IV systematic reviews and meta-analyses.

Intercostal Cryo Nerve Block in Minimally Invasive Cardiac Surgery: The Prospective Randomized FROST Trial

“…Previous reports have suggested reduced opioid use after cryoanalgesia compared to conventional analgesia methods in thoracotomy procedures [ 16 , 29 ]. A recent systematic review of cryoanalgesia used in thoracic procedures concluded that intercostal cryoanalgesia may decrease inpatient narcotic use [ 30 ]. Therefore, future studies could be focused on further evaluating the impact of CryoNB on opioid requirements in minimally invasive cardiac procedures on cardiopulmonary bypass.…”

Intercostal nerve cryoablation during surgical stabilization of rib fractures

“…Reported complications in contemporary literature include chest wall paresthesia and spontaneously resolving hematoma. 14 Neuralgia, reported in up to 20% to 30% of IC patients in early studies, has not been reported in contemporary literature. Variable follow-up durations and reporting of complications preclude estimating IC complication rates, but among 17 patients who were followed up long-term, our study found that only one patient reported minor chest wall paresthesia.…”

Intercostal Cryoneurolysis

“…Intercostal ablation has emerged as a treatment modality for patients suffering from intercostal pain of various etiologies. [2][3][4][5][6][7] Intercostal cryoneurolysis (IC) involves using extreme cold to cause Wallerian degeneration of the targeted intercostal nerve. The intercostal nerves arise from the anterior spinal nerve root divisions of the anterior primary rami of T1-T12 to innervate the thoracic wall and parietal pleura.…”

“…IC for chest wall pain has been associated with various degrees of decreased pain and narcotic utilization. 3 In addition, the therapy has demonstrated success in alleviating pain involving chest wall and upper abdominal pain secondary to malignancy, 6 intercostal neuralgia, 9 pectus excavatum repair, 4 and postthoracotomy pain syndrome. 10 Herein we provide a technical overview of how to perform intercostal block and cryoneurolysis as well as explore the various etiologies of chest wall pain for the utilization of IC in those spaces.…”