Can the effects of cryo-analgesia be improved by decreasing the number of intercostal levels and treatment time?

P0166 

Abstract Submission 

Benny Weksler (1), Lauren Drake (2), Kara Specht (3), Pam Kuchta (3), Lawrence Crist (2), Hiran Fernando (4)

(1) Allegheny Health network, Pittsburgh, PA, (2) Allegheny Health Network, Pittsburgh, PA, (3) Allegheny General Hospital, Pittsburgh, PA, (4) Allegheny General Hospital, Oakmont, PA

*Benny Weksler    -  Contact Me
Allegheny Health network

Lauren Drake    -  Contact Me
Allegheny Health Network

Kara Specht    -  Contact Me
Allegheny General Hospital

Pam Kuchta    -  Contact Me
Allegheny General Hospital

Lawrence Crist    -  Contact Me
Allegheny Health Network

*Hiran Fernando    -  Contact Me
Allegheny General Hospital

Lauren Drake    -  Contact Me
Memorial Sloan Kettering Cancer Center

Objective: We recently presented a negative randomized trial comparing cryo-analgesia at 6 intercostal levels for 120 seconds with our standard of care. Several patients in the trial complained of prolonged pain and neuropathy. We hypothesized that by decreasing the number of intercostal spaces treated and the treatment time, cryo-analgesia may reduce the consumption of narcotics.

Methods: This study was a quality improvement project. We treated 60 consecutive patients (QI) undergoing elective robotic pulmonary resections. Fifteen patients were excluded due to opioid or gabapentin use. Patients received intercostal nerve block with bupivacaine and lidocaine (INB) and cryotherapy to 3 levels for 90 seconds. Results were compared to the results of the randomized trial, which had two cohorts: the cryotherapy cohort (Cryo) was treated with cryoablation of six intercostal nerves for 120 seconds in addition to INB. The standard of care cohort (SOC) was treated with INB only. Primary outcomes were opioid use in-hospital and totaled up to the first postop visit measured by morphine milligram equivalents (MME). Secondary outcomes included patient-reported pain as assessed by the visual analog scale (VAS) and the difference in incentive spirometry (IS) between preoperative value and postoperative days (POD) 1 and 2.

Results: 148 patients were analyzed (Cryo N=51, SOC N=52, QI N=45). There was no difference in baseline characteristics, procedure type, or length of stay. There was no difference in inpatient MME, outpatient MME, or total MME up to the first postoperative visit. The difference between preoperative IS and IS at postoperative days 1 and 2 was insignificant. Pain scores were similar among the 3 groups (Table 1).

Conclusions: Modifying the cryo-analgesia protocol to include fewer levels and less time did not improve opioid consumption, incentive spirometry, or pain scores in patients undergoing lung resection. The technology should not be used outside of clinical trials.

Innovations: New devices or novel approaches, preclinical or clinical