Bedside percutaneous cryoneurolysis technique for management of acute rib fracture pain in adult trauma patients.

IF 2.1 Q3 CRITICAL CARE MEDICINE
Trauma Surgery & Acute Care Open Pub Date : 2024-08-22 eCollection Date: 2024-01-01 DOI:10.1136/tsaco-2024-001521
Cynthia I Villalta, Rabiya K Mian, Heather M Grossman Verner, Dana Farsakh, Timothy C Browne, Zachary S Goldstein, Conner McDaniel
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引用次数: 0

Abstract

Background: Acute pain due to rib fractures causes significant in-hospital morbidity and impacts patients' quality of life after discharge. Intraoperative transthoracic cryoneurolysis of the intercostal nerves can improve postoperative pain; however, non-surgical patients are provided limited analgesia options. Here, we describe our experience with a bedside cryoanalgesia technique for management of acute rib fracture pain.

Methods: Five patients at a single level I trauma center completed bedside intercostal nerve cryoneurolysis (INC) using a handheld cryotherapy device and ultrasound guidance. Relative pain ratings (scale 0-10/10) and maximal incentive spirometry (ISmax) volumes were taken prior to the procedure as a baseline. Patients were observed for 24 hours after procedure, with relative pain ratings and ISmax recorded at 1, 8, 16, and 24 hours after procedure.

Results: Our patients were 29-88 years old and had one to five single-sided rib fractures. At baseline, they had high pre-procedure pain ratings (7-10/10) and ISmax volumes of 800-2000 mL. Many had improvements in their pain rating but little change in their ISmax at 1 hour (1-5/10 and 1000-2000 mL, respectively) and 8 hours (1-5/10 and 1250-2400 mL, respectively). ISmax volumes improved by 16 hours (1500-2400 mL) with comparable pain ratings (0-5/10). At 24 hours, pain ratings and ISmax ranged from 0 to 8/10 and from 1500 mL to 2400 mL, respectively. Each patient had improved pain control and ISmax volumes compared with their pre-procedure values. All patients reported the procedure as an asset to their recovery at discharge.

Conclusions: Our study demonstrates patients with rib fractures may experience improved pain ratings and ISmax values after INC. Percutaneous INC appears to be a viable adjunct to multimodal pain control for patients with rib fractures and should be considered in patients with difficult pain control. Further studies are required to fully assess INC safety, efficacy, post-discharge outcomes, and utility in patients with altered mental status or on mechanical ventilation.

Level of evidence: Level V, case series.

治疗成人创伤患者急性肋骨骨折疼痛的床旁经皮冷冻神经溶解技术。
背景:肋骨骨折引起的急性疼痛会导致严重的院内发病率,并影响患者出院后的生活质量。术中对肋间神经进行经胸冷冻神经溶解可以改善术后疼痛;然而,非手术患者的镇痛选择有限。在此,我们介绍了床旁低温镇痛技术治疗急性肋骨骨折疼痛的经验:方法:一家一级创伤中心的五名患者使用手持冷冻治疗设备和超声引导完成了肋间神经冷冻神经溶解术(INC)。术前采集相对疼痛评分(0-10/10 分)和最大激励肺活量(ISmax)作为基线。术后观察患者 24 小时,记录术后 1、8、16 和 24 小时的相对疼痛评分和 ISmax:我们的患者年龄在 29-88 岁之间,有一到五根单侧肋骨骨折。基线时,他们的术前疼痛评分较高(7-10/10),ISmax 容量为 800-2000 mL。许多人的疼痛评分有所改善,但在 1 小时(分别为 1-5/10 和 1000-2000 毫升)和 8 小时(分别为 1-5/10 和 1250-2400 毫升)时,他们的 ISmax 变化不大。16 小时后,ISmax 容量有所改善(1500-2400 毫升),但疼痛评分(0-5/10)不相上下。24 小时后,疼痛评分和 ISmax 分别为 0 至 8/10 和 1500 mL 至 2400 mL。与手术前相比,每位患者的疼痛控制和ISmax量都有所改善。所有患者在出院时都表示手术对他们的康复很有帮助:我们的研究表明,肋骨骨折患者在接受 INC 术后,疼痛评分和 ISmax 值均有所改善。经皮 INC 似乎是肋骨骨折患者多模式疼痛控制的一种可行的辅助方法,疼痛控制困难的患者应考虑使用。还需要进一步的研究来全面评估 INC 的安全性、有效性、出院后的疗效以及对精神状态改变或使用机械通气的患者的作用:证据等级:V 级,病例系列。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.70
自引率
5.00%
发文量
71
审稿时长
12 weeks
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