Reducing treatment time and number of nerves treated fails to improve cryoanalgesia outcomes

Objective: Cryoanalgesia is an attractive method to improve postoperative pain. However, our randomized trial did not show significant reduction in pain or opioid use in adults undergoing minimally invasive thoracic surgery. We hypothesized that reducing the number of intercostal spaces and treatment time may decrease postoperative pain and narcotic consumption. Methods: In this quality improvement study, the quality improvement cohort received an intercostal nerve block with bupivacaine and lidocaine, and cryotherapy to 3 levels for 90 seconds. Outcomes from this cohort were compared with outcomes from our randomized trial cohorts: The cryoanalgesia cohort was treated with cryotherapy to 5 to 6 intercostal nerves for 120 seconds and intercostal nerve block, and the standard of care cohort was treated with intercostal nerve block only. Primary outcomes were opioid consumption up to the first postoperative visit measured by morphine milligram equivalents. Secondary outcomes included patient-reported pain and incentive spirometry volumes in the immediate postoperative period. Results: A total of 161 patients were analyzed (quality improvement N = 58, standard of care N = 52, cryoanalgesia N = 51). There was no difference in baseline characteristics, procedure type, or length of stay. There were no differences in inpatient or total morphine milligram equivalents up to the first postoperative visit. Outpatient morphine milligram equivalents were significantly higher in the quality improvement cohort (P = .029). Patient-reported pain scores were similar among all groups, and there were no significant differences in incentive spirometry volumes. Conclusions: Modifying the cryoanalgesia protocol to include fewer levels and less time did not improve opioid consumption, incentive spirometry, or pain scores in patients undergoing lung resection.