Intercostal nerve cryoablation in lung transplantation: A single-center, propensity score–matched analysis

Background

Achieving adequate pain control after lung transplantation is an essential milestone in a patient's recovery. We compared postoperative opioid use, clinical outcomes, and respiratory function in lung transplant recipients treated with intercostal nerve cryoablation (INC) compared to those receiving standard pain management.

Methods

We reviewed all adult lung transplants performed at our center between January 2016 and December 2022. We excluded cases performed through median sternotomy and patients with prior thoracotomies, multiorgan transplants, and redo transplants. We performed a propensity score–matched analysis, comparing patients who received INC versus those who received standard pain management. The primary outcome was cumulative postoperative opioid use in morphine milligram equivalents (MME) by postoperative day (POD) 14. Secondary outcomes included opioid use on POD5 and POD10, perioperative outcomes, 1-year survival, and longitudinal measurement of respiratory function.

Results

Propensity score matching resulted in 85 patients in each group. Compared to the standard pain management group, the INC group had a lower cumulative opioid use by POD14 (509 MME vs 864 MME; P = .032). In addition, the INC group had less opioid use at POD5, POD10, and POD14; no difference in perioperative outcomes; and similar 1-year survival. The INC group had better respiratory function at 6 and 12 months post-transplant compared to the standard pain management group.

Conclusions

In our single-center analysis, INC was associated with less opioid use and improved respiratory function after lung transplant. This report adds to the growing literature supporting the use of INC in multimodal pain management strategies and enhanced recovery protocols in lung transplant.