Impact of intercostal nerve cryoablation for aortic repair with left thoracotomy: decrease postoperative opioid use and encourage lung expansion

P0156 

Abstract Submission 

JUNJI NAKAZAWA (1), Yutaka Iba (1), Tomohiro Nakajima (1), Tsuyoshi Shibata (1), Shuhei Miura (1), Ayaka Arihara (1), Keitaro Nakanishi (1), Takatakimi Mizuno (1), Kei Mukawa (1), Nobuyoshi Kawaharada (1)

(1) Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo, Hokkaido

Junji Nakazawa    -  Contact Me
Department of Cardiovascular Surgery, Sapporo Medical University

Yutaka Iba    -  Contact Me
Department of Cardiovascular Surgery, Sapporo Medical University

Tomohiro Nakajima    -  Contact Me
Department of Cardiovascular Surgery, Sapporo Medical University

Tsuyoshi Shibata    -  Contact Me
Department of Cardiovascular Surgery, Sapporo Medical University

Shuhei Miura    -  Contact Me
Department of Cardiovascular Surgery, Sapporo Medical University

Ayaka Arihara    -  Contact Me
Department of Cardiovascular Surgery, Sapporo Medical University

Keitaro Nakanishi    -  Contact Me
Department of Cardiovascular Surgery, Sapporo Medical University

Takakimi Mizuno    -  Contact Me
Department of Cardiovascular Surgery, Sapporo Medical University

Kei Mukawa    -  Contact Me
Department of Cardiovascular Surgery, Sapporo Medical University

Nobuyoshi Kawaharada    -  Contact Me
Department of Cardiovascular Surgery, Sapporo Medical University

Junji Nakazawa    -  Contact Me
Sapporo medical university

Objective: Left thoracotomy for aortic repair often causes unbearable pain post-surgery. Nevertheless, various analgesics are used. The efficacy of intercostal nerve cryoablation for pain management after pectoris excavatum repair and lung resection has been reported. In this study, the impact of intercostal nerve cryoablation after aortic repair with thoracotomy was evaluated.

Methods: From January 2017 to July 2023, 72 patients underwent aortic repair with thoracotomy in our facility. After excluding emergency or infected aneurysm cases, 62 patients participated in this study. The primary outcome was the mean pain score during the first 5 days post-surgery using a numerical rating scale (1–10). Secondary outcomes were the rate of opioid use and the lung volume ratio assessed by computed tomography at 1 week post-surgery. These variables were compared between the two groups: thoracotomy with cryoablation for intercostal nerve block (cryoablation group) and thoracotomy without cryoablation (non-cryoablation group).

Results: The cryoablation group had 32 patients, and the non-cryoablation group had 30 patients. The mean age was 64.3 and 61.2 years, respectively, and other patients' characteristics, which were sex, physique, comorbidities, and operation time, were not significantly different. The mean pain score was lower in the cryoablation group (1.7 ± 0.9) than in the non-cryoablation group (2.4 ± 0.8; p < 0.01). The rate of opioid use was also lower in the cryoablation group (6.2%) than in the non-cryoablation group (56.6%; p < 0.01). The left lung volume ratio at 1 week post-surgery to preoperative value was larger in the cryoablation group (72.3%) than in the non-cryoablation group (62.4%; p = 0.05).

Conclusion: Intercostal nerve cryoablation showed good pain management. Furthermore, this procedure decreased opioid use and encouraged lung expansion post-surgery.

Anesthesia and Perioperative Management