Cryoablation for Chest Wall Trauma: A Brief Report

Abstract

Respiratory failure secondary to rib fractures is a major source of morbidity and mortality in trauma patients, particularly in older populations. Management of pain in these patients is complex due to the nature of the injuries. We present 3 patients who underwent a video-assisted thoracoscopic cryoablation of intercostal nerves for pain control after chest trauma. None of the patients developed post-operative complications related to poor respiratory status such as pneumonia or atelectasis. At one-month clinic follow-up, all patients reported no chest pain and were not using opiate analgesics. In patients for whom there is a contraindication to rib fixation in the setting of unstable rib fractures, cryoablation may be a method by which to improve respiratory status and decrease ventilator dependency due to pain. Cryoablation of intercostal nerves may provide a more durable and clinically feasible solution to aid in the healing process of these patients.

Intercostal Nerve Cryoablation Reduces Opioid Use and Length of Stay Without Increasing Adverse Events

“…The small sample sizes have led to conflicting results about rates of less common adverse events, such as rates of bar displacement 18,20,23,25,27 . With this information not yet widely available, and applications to other patient populations limited, intercostal nerve cryoablation has not been broadly adopted for thoracic surgery and it remains uncovered by most insurance companies 28–30 …”

“…18,20,23,25,27 With this information not yet widely available, and applications to other patient populations limited, intercostal nerve cryoablation has not been broadly adopted for thoracic surgery and it remains uncovered by most insurance companies. [28][29][30] The purpose of this study was to assess trends in the use of cryoablation for perioperative analgesia during SCOPE among children's hospitals in the United States and examine its association with opioid use and other surgical outcomes. Based on the aggregate of previous literature and our experience with the technique, we hypothesized that cryoablation would decrease inpatient opioid use and length of stay of a surgical admission while having no effect on revisions, revisits, surgical complications, or chest tubes placed outside the operating room.…”