CT-Guided Cryoneurolysis Effective for Rib Fracture Pain in Older Adults: JAMA
USA: A study published on August 7 in JAMA Surgery finds that CT-guided cryoneurolysis, a technique involving the freezing of nerves to relieve pain, is both safe and effective for older adults with rib fractures.
Rib fractures are frequently encountered in older adults and can lead to severe complications if pain is not managed effectively. Evidence suggests that implementing evidence-based approaches, such as neuraxial blockade and surgical stabilization of rib fractures (SSRF), can reduce both morbidity and mortality in patients aged 65 and older. However, these methods come with certain limitations.
Against the above background, Simeng Wang, Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, and colleagues conducted a recent case series in which a minimally invasive procedure was performed on older adults with rib fractures who were not candidates for standard surgical stabilization due to their comorbidities.
The study, which focused on participants over 65 years and was conducted within 72 hours of their hospital admission, evaluated the effectiveness of CT-guided cryoneurolysis targeting intercostal nerves.
The cohort included 38 patients with a mean age of 75.6 years, who were ineligible for surgery and had a median of four rib fractures ranging from ribs three to nine. These patients reported a pain score of five or higher upon deep inspiration. Using a 1.7-millimeter percutaneous cryoablation probe (Endocare PCS-17RS, Varian), the procedure was guided by CT imaging.
Out of the 38 participants, 82% completed the 30-day follow-up. Results showed a significant reduction in median numeric pain scores, decreasing from 8 (range 7-9) before the procedure to 5.5 at discharge. By the 30-day follow-up, median pain scores had further decreased to 2. The median hospital stay was four days.
The authors concluded that percutaneous cryoneurolysis of intercostal nerves (PCNIN) proved to be a safe and effective method for managing pain in older adults with rib fractures. They highlighted the potential of this technique as an alternative to invasive surgical options and a means to reduce opioid use.
However, the study acknowledged limitations, including the small sample size and the potential lack of generalizability due to the single-institution setting. The researchers recommended further investigation through a larger, randomized clinical trial to better assess the benefits of PCNIN for this patient population.
Reference:
Wang S, Earley M, Kesselman A, et al. Percutaneous Cryoneurolysis for Pain Control After Rib Fractures in Older Adults. JAMA Surg. Published online August 07, 2024. doi:10.1001/jamasurg.2024.2063
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