Intercostal nerve cryoablation for control of pain after sternal fracture repair: A case series.

Abstract

Introduction: Sternal fractures resulting from blunt chest trauma, can present with significant pain and respiratory compromise, particularly in patients with polytrauma. While isolated, nondisplaced fractures are typically managed conservatively, displaced or painful fractures are higher risk and may warrant surgical intervention. Intercostal cryoneurolysis (IC) has emerged as a promising adjunct, offering enhanced pain control in thoracic procedures. However, no studies have characterized the role of IC in the management of traumatic sternal fractures.

Case report: We present two cases of patients with displaced sternal fractures following motor vehicle collisions who underwent surgical fixation with adjunctive IC. Both patients reported severe preoperative sternal pain unrelieved by multimodal analgesia. Intraoperative IC was performed bilaterally at the level of the fracture and adjacent intercostal spaces using a cryoanalgesia probe. Postoperatively, both patients experienced immediate and sustained pain relief, with complete insensate status over the sternal region and no complications. One patient was discharged the day after surgery and resumed normal activities, while the other remained hospitalized until postoperative day 7 for management of associated orthopedic injuries.

Discussion: These cases demonstrate that IC, when used alongside sternal fixation, can provide rapid, effective, and durable pain relief, potentially reducing reliance on opioids and facilitating early mobilization. While further research is needed to establish standardized protocols, these findings support the integration of IC into the surgical management of traumatic sternal fractures.