Cryoablation in lung transplantation: Its impact on pain, opioid use, and outcomes

Koons, Brittany; Suzuki, Yoshikazu; Cevasco, Marisa; Bermúdez, C.; Harmon, Michael T.; Dallara, Laura; Ramon, Christian V.; Nottingham, Ana; Ganjoo, Nikhil; Diamond, Joshua M.; Christie, Jason D.; Localio, A. Russell; Cantu, Edward

doi:10.1016/j.xjon.2022.11.005

Cited by 7 publications

(3 citation statements)

References 29 publications

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“…Chronic opioid use was also lower in the intervention group. No significant differences in perioperative outcomes such as ventilation time or hospital stay, but survival at 30 days and 1 year was better in the intervention group 51 …”

Section: Intercostal Nerve Block and Cryoablationmentioning

confidence: 82%

Regional analgesia for lung transplantation

Azem

Mangoubi

Zribi

et al. 2023

European Journal of Anaesthesiology

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Lung transplantation (LTx) is the definitive treatment for end-stage pulmonary disease. About 4500 LTxs are performed annually worldwide.It is considered challenging and complex surgery regarding anaesthesia and pain management. While providing adequate analgesia is crucial for patient comfort, early mobilisation and prevention of postoperative pulmonary complications, standardising an analgesic protocol is challenging due to the diversity of aetiologies, surgical approaches and the potential use of extracorporeal life support (ECLS).Although thoracic epidural analgesia is commonly considered the gold standard, concerns regarding procedural safety and its potential for devastating consequences have led physicians to seek safer analgesic modalities such as thoracic nerve blocks.The advantages of thoracic nerve blocks for general thoracic surgery are well established. However, their utility in LTx remains unclear.Considering paucity of relevant literature, this review aims to raise awareness about the literature gap in the field and highlight the need for further high-quality studies determining the effectiveness of available techniques.

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Section: Intercostal Nerve Block and Cryoablationmentioning

confidence: 82%

Regional analgesia for lung transplantation

Azem

Mangoubi

Zribi

et al. 2023

European Journal of Anaesthesiology

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“…14 While some centers adopt TEA as a corner stone of multimodal analgesia, 15 other centers use systemic opioids for most of their patients and reserve TEA only if severe pain is expected or systemic opioids have failed. 5 More recently, intercostal nerve blockade with cryoablation 16,17 or liposomal bupivacaine 18 have been suggested as a safe and effective component of multimodal opi-oid sparing analgesia. At our institution, we employ a lung transplant pain management algorithm to guide perioperative pain control via an epidural or a non-epidural pathways (Figure S1).…”

Section: Discussionmentioning

confidence: 99%

Pain trajectories after bilateral orthotopic lung transplantation surgery performed via a clamshell incision

Mamoun,

Rosser,

Manning

et al. 2024

Clinical Transplantation

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IntroductionThe nature, intensity, and progression of acute pain after bilateral orthotopic lung transplantation (BOLT) performed via a clamshell incision has not been well investigated. We aimed to describe acute pain after clamshell incisions using pain trajectories for the study cohort, in addition to stratifying patients into separate pain trajectory groups and investigating their association with donor and recipient perioperative variables.MethodsAfter obtaining IRB approval, we retrospectively included all patients ≥18 years old who underwent primary BOLT via clamshell incision at a single center between January 1, 2017, and June 30, 2022. We modeled the overall pain trajectory using pain scores collected over the first seven postoperative days and identified separate pain trajectory classes via latent class analysis.ResultsThree hundred one adult patients were included in the final analysis. Three separate pain trajectory groups were identified, with most patients (72.8%) belonging to a well‐controlled, stable pain trajectory. Uncontrolled pain was either observed in the early postoperative period (10%), or in the late postoperative period (17.3%). Late postoperative peaking trajectory patients were younger (p = .008), and sicker with a higher lung allocation score (p = .005), receiving preoperative mechanical ventilation (p < .001), or VV‐ECMO support (p < .001).ConclusionDespite the extensive nature of a clamshell incision, most pain trajectories in BOLT patients had a well‐controlled stable pain profile. The benign nature of pain profiles in our patient population may be attributed to the routine institutional practice of early thoracic epidural analgesia for BOLT patients unless contraindicated.

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“…Immediate interruption of sedation in critically ill patients after abdominal surgery resulted in a marked reduction in the time to successful extubation compared with usual care (median, 8 vs. 50 h) 19 . The use of opiate analgesics is minimized with intercostal nerve cryoablation during surgery or early epidural catheter placement for inadequate pain control 20,21 . If PaO 2 /FiO 2 ratio exceeds 200, the chest radiograph has no major abnormalizes, and hemodynamics are stable, then ventilator modality is changed to pressure-support adjusted to an adequate tidal volume and respiratory rate 22 .…”

Section: Respiratorymentioning

confidence: 99%

Pulmonary, circulatory and renal considerations in the early postoperative management of the lung transplant recipient

Girgis

Hadley

Murphy

2023

gcsp

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Lung transplantation volumes and survival rates continue to increase worldwide. Primary graft dysfunction (PGD) and acute kidney injury (AKI) are common early postoperative complications that significantly affect short-term mortality and long-term outcomes. These conditions share overlapping risk factors and are driven, in part, by circulatory derangements. The prevalence of severe PGD is up to 20% and is the leading cause of early death. Patients with pulmonary hypertension are at a higher risk. Prevention and management are based on principles learned from acute lung injury of other causes. Targeting the lowest effective cardiac filling pressure will reduce alveolar edema formation in the setting of increased pulmonary capillary permeability. AKI is reported in up to one-half of lung transplant recipients and is strongly associated with one-year mortality as well as long-term chronic kidney disease. Optimization of renal perfusion is critical to reduce the incidence and severity of AKI. In this review, we highlight key early post- transplant pulmonary, circulatory, and renal perturbations and our center’s management approach.

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Cryoablation in lung transplantation: Its impact on pain, opioid use, and outcomes

Cited by 7 publications

References 29 publications

Regional analgesia for lung transplantation

Regional analgesia for lung transplantation

Pain trajectories after bilateral orthotopic lung transplantation surgery performed via a clamshell incision

Pulmonary, circulatory and renal considerations in the early postoperative management of the lung transplant recipient

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