P166. Can the effects of cryo-analgesia be improved by decreasing the number of intercostal levels and treatment time?
Allegheny Health network
Pittsburgh, PA
United States - Contact Me
I am a PGY 3 general surgery resident at Allegheny Health Network. I recently completed a two-year research fellowship in the lab of Dr. Prasad Adusumilli at Memorial Sloan Kettering Cancer Center. While in the lab, I developed a skill set to analyze the tumor immune microenvironment, focusing specifically on features of response versus no response to induction therapy in lung adenocarcinoma. As a resident, I have continued research in the clinical setting with Dr. Benny Weksler, where the focus of my project is on evaluating cryoanalgesia as a potential treatment modality to reduce pain in patients undergoing minimally invasive thoracic surgery. With the experience I have gained in translational and clinical research, I look forward to advancing my skill set as I pursue a career in academic thoracic surgery.
Description
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.
Authors
Benny Weksler (1), Lauren Drake (2), Kara Specht (3), Pam Kuchta (3), Lawrence Crist (2), Hiran Fernando (4)
Institutions
(1) Allegheny Health network, Pittsburgh, PA, (2) Allegheny Health Network, Pittsburgh, PA, (3) Allegheny General Hospital, Pittsburgh, PA, (4) Allegheny General Hospital, Oakmont, PA