Feasibility and Safety of Intercostal Cryoneurolysis During Pleuroscopy: A Novel Analgesic Approach Using a 1.7 mm Cryoprobe

Abstract

Introduction

Pleuroscopy is a minimally invasive and highly effective procedure used for diagnosing pleural diseases. Despite its utility, pain during and after the procedure can be significant. Traditional analgesic approaches, including systemic opioids and local anaesthetics albeit potent, may provide incomplete pain relief and can be associated with side effects. Cryoneurolysis has emerged as a feasible analgesic technique in general surgery. However, an equivalent treatment modality has yet to be established for pleuroscopy.

Objectives

To investigate the safety and feasibility of cryoneurolysis in pleuroscopy performed using a 1.7 mm cryoprobe via a semi-rigid pleuroscope.

Materials and methods

We conducted a prospective, single-centre observational study on 43 patients who underwent pleuroscopy at our institution between January 2024 and December 2024, of which 25 received cryoneurolysis. Pain levels were assessed using a Numeric Rating Scale (NRS) immediately post-procedure and at 24 and 72 h. Complications and long-term adverse events were documented.

Results

NRS scores after cryoneurolysis showed successful pain management both immediately post-procedure (mean NRS: 3.1) and at subsequent time points (24 h: 2.0; 72 h: 1.5). No major complications, such as major haemorrhage or nerve injury leading to persistent deficits, were observed. Minor complications occurred in 2 patients, who experienced a transient numbness immediately post-procedure. Analgesic requirements were lower than the control group, with 68% of patients requiring only mild oral analgesics post-procedurally.

Conclusion

The use of cryoneurolysis during pleuroscopy appears to be a feasible, safe, and effective technique for pain management. However, further studies with larger cohorts are warranted to validate the findings.