Bedside percutaneous cryoneurolysis technique for management of acute rib fracture pain in adult trauma patients

Abstract

BackgroundAcute pain due to rib fractures causes significant in-hospital morbidity and impacts patients’ quality of life after discharge. Intraoperative transthoracic cryoneurolysis of the intercostal nerves can improve postoperative pain; however, non-surgical patients are provided limited analgesia options. Here, we describe our experience with a bedside cryoanalgesia technique for management of acute rib fracture pain.MethodsFive patients at a single level I trauma center completed bedside intercostal nerve cryoneurolysis (INC) using a handheld cryotherapy device and ultrasound guidance. Relative pain ratings (scale 0–10/10) and maximal incentive spirometry (ISmax) volumes were taken prior to the procedure as a baseline. Patients were observed for 24 hours after procedure, with relative pain ratings and ISmaxrecorded at 1, 8, 16, and 24 hours after procedure.ResultsOur patients were 29–88 years old and had one to five single-sided rib fractures. At baseline, they had high pre-procedure pain ratings (7–10/10) and ISmaxvolumes of 800–2000 mL. Many had improvements in their pain rating but little change in their ISmaxat 1 hour (1–5/10 and 1000–2000 mL, respectively) and 8 hours (1–5/10 and 1250–2400 mL, respectively). ISmaxvolumes improved by 16 hours (1500–2400 mL) with comparable pain ratings (0–5/10). At 24 hours, pain ratings and ISmaxranged from 0 to 8/10 and from 1500 mL to 2400 mL, respectively. Each patient had improved pain control and ISmaxvolumes compared with their pre-procedure values. All patients reported the procedure as an asset to their recovery at discharge.ConclusionsOur study demonstrates patients with rib fractures may experience improved pain ratings and ISmaxvalues after INC. Percutaneous INC appears to be a viable adjunct to multimodal pain control for patients with rib fractures and should be considered in patients with difficult pain control. Further studies are required to fully assess INC safety, efficacy, post-discharge outcomes, and utility in patients with altered mental status or on mechanical ventilation.Level of evidenceLevel V, case series.