Eastern Cardiothoracic Surgical Society

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Intercostal Nerve Cryoanalgesia Reduces Opioid Use after Video-Assisted Thoracoscopic Surgery
Nick Levinsky, Karthik Thangappan, Robert M. Van Haren, Sandra L. Starnes, Julian Guitron.
University of Cincinnati, Cincinnati, OH, USA.

OBJECTIVE: The national opioid epidemic mandates the optimization of the use of postoperative narcotic pain medication. We aim to test the hypothesis that intercostal nerve cryoanalgesia reduces opioid use after video-assisted thoracoscopic surgery (VATS) pulmonary resections.
METHODS: A retrospective review of patients undergoing VATS pulmonary resections with or without intercostal nerve cryoanalgesia from August, 2015, to June, 2018, was conducted. The primary endpoint was opioid requirement at discharge. Secondary endpoints included average daily inpatient opioid use, opioid prescriptions filled within 3 months postoperatively, and the need for neuropathic pain medication. Narcotic requirements are reported in milligram morphine equivalents (MME).
RESULTS: A cohort of 41 patients had an average age of 63, with 18 undergoing lobectomy (43.9%) and 23 undergoing sub-lobar resection (56.9%). Twenty patients received cryoanalgesia while 21 received standard pain control. The groups had similar demographics, pre-operative opioid use, and epidural use. Patients who underwent cryoanalgesia experienced a greater than 50% reduction in average daily inpatient opioid use (median [IQR], 21.3mg [5.1 - 41.4] vs 48.8mg [14.7 - 74.9], p=0.03), and a significant reduction in opioid prescription needs at discharge (mean SD, 465mg 243 vs 702mg 369, p=0.047). At 3 months post-operatively, there was no difference in opioid prescribing between groups (p=0.84), but there was a trend toward higher use of neuropathic pain medication for patients who received cryoanalgesia (40% [n=8] vs 14.3% [n=3], p=0.085) (Table).
CONCLUSIONS: Cryoanalgesia may be a useful adjunct for non-opioid pain control after VATS, decreasing both inpatient and discharge opioid needs.


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