Bilateral Intercostal Cryoanalgesia After Sternotomy for Coronary Artery Bypass Grafting.

Abstract

Background: Effective opioid-sparing analgesia after median sternotomy remains an unmet need in cardiac surgery. We evaluated whether bilateral intercostal cryoanalgesia, added to standard multimodal analgesia, was associated with postoperative pain, opioid consumption, recovery and early hospital-resource use after isolated coronary artery bypass grafting (CABG).

Methods: This single-centre, non-randomised comparative service evaluation included 60 patients undergoing isolated CABG through median sternotomy between 1 November 2025 and 30 May 2026 (30 cryoanalgesia; 30 standard care). The prespecified primary endpoint was cumulative movement-evoked pain burden, quantified as the area under the curve (AUC) for scores recorded on postoperative days 1-3. Secondary endpoints included rest-pain AUC, opioid consumption expressed as oral morphine equivalents (OME), time to first bowel opening, postoperative length of stay and an exploratory break-even calculation.

Results: Cryoanalgesia was associated with lower movement-pain AUC (adjusted mean difference -3.56 score-days, 95% confidence interval [CI] -4.62 to -2.50; p < 0.001) and rest-pain AUC (-3.16 score-days, 95% CI -4.19 to -2.14; p < 0.001). Total observed opioid consumption was lower by 112.9 mg OME (95% CI -192.8 to -33.1; p = 0.006), length of stay by 1.32 days (95% CI -1.93 to -0.71; p < 0.001), and time to first bowel opening by 0.49 days (95% CI -0.92 to -0.06; p = 0.027).

Conclusions: In this small non-randomised evaluation, bilateral intercostal cryoanalgesia was associated with lower early pain and opioid exposure and faster recovery. Selection, temporal and residual confounding preclude causal or cost-effectiveness conclusions. Prospective randomised evaluation with fixed observation periods and longer-term safety follow-up is required.