Freezing Pain Away after rib fracture: Cryoneurolysis for Lasting Relief, suggests study

Recent study focused on comparing the effectiveness of ultrasound-guided percutaneous cryoneurolysis to intercostal nerve blocks in managing pain, reducing opioid consumption, and improving pulmonary function in patients with traumatic rib fractures. The hypothesis was that cryoneurolysis would improve analgesia and inspire volume after rib fracture compared to the control treatment.

A randomized controlled trial with 20 participants evaluated the outcomes. Cryoneurolysis significantly improved maximum inspired lung volume and reduced pain immediately post-treatment and continued to do so throughout the first month compared to the control group. The cryoneurolysis group showed a 100% to 188% improvement in inspired volume compared to 30% improvement in the control group. Pain scores were consistently lower in the cryoneurolysis group, and total cumulative oxycodone equivalents were significantly lower in this group.

Pain Reduction and Outcomes

The study found that cryoneurolysis reduced pain interference, decreased opioid consumption by 89%, and lowered the frequency of awakenings due to pain. Cryoneurolysis patients reported no pain after one month post-treatment compared to the control group, where some participants still experienced pain. The study did not identify any systemic side effects or complications related to cryoneurolysis.

Limitations and Conclusion

The limitations of the study include a small sample size and the need for further research to confirm the findings in a larger trial. Cryoneurolysis was shown to have long-lasting effects, avoiding systemic side effects of opioids, and reducing the burden on patients and healthcare providers. Cryoneurolysis is a potential alternative for managing pain after traumatic rib fractures, offering prolonged pain relief without the risks associated with traditional treatments.

Overall Study Evaluation

Overall, the study suggests that cryoneurolysis is a promising intervention for improving pain management, reducing opioid use, and enhancing pulmonary function in patients with rib fractures. However, further research with a larger sample size is necessary to validate these preliminary findings and determine the long-term benefits and potential risks associated with cryoneurolysis.

Key Points

- The study compared ultrasound-guided percutaneous cryoneurolysis to intercostal nerve blocks for managing pain, reducing opioid consumption, and improving pulmonary function in patients with traumatic rib fractures.

- Cryoneurolysis significantly improved maximum inspired lung volume, reduced pain immediately post-treatment, and continued to do so throughout the first month compared to the control group.

- Cryoneurolysis group showed a 100% to 188% improvement in inspired volume compared to a 30% improvement in the control group.

- Cryoneurolysis reduced pain interference, decreased opioid consumption by 89%, and lowered the frequency of awakenings due to pain, with some patients reporting no pain one month post-treatment.

- No systemic side effects or complications related to cryoneurolysis were identified during the study.

- Cryoneurolysis is a promising intervention that offers prolonged pain relief without the risks associated with traditional treatments, but further research with a larger sample size is needed to confirm these findings and understand the long-term benefits and potential risks.

Reference –

J. Finneran et al. (2024). Ultrasound-Guided Percutaneous Cryoneurolysis For The Treatment Of Pain After Traumatic Rib Fracture: A Randomized, Active-Controlled, Participant- And Observer-Masked Study. *Anesthesiology*, 142, 532 - 545. https://doi.org/10.1097/aln.0000000000005328.