Injury · 2025
Ultrasound-guided percutaneous cryoneurolysis of intercostal nerves in traumatic rib fractures.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Forrester Joseph D, Wang Simeng, Myers Alexandra A, Earley Michelle, Guthrie-Baker Sydney, Abreo Anisha, Knight Ariel W, Tung Jamie
Аннотация
BACKGROUND: Multimodal pain control is the cornerstone of managing acute traumatic rib fractures. We employed surgeon-administered, ultrasound-guided percutaneous cryoneurolysis of intercostal nerves (USPCNIN) as an adjunct opioid-sparing analgesic modality at the bedside.
METHODS: This was a single-institution case series. Patients between 18-64 years of age who sustained traumatic rib fracture between ribs 3-9, deemed ineligible for surgical stabilization, and had pre-procedure numeric pain scores ≥5 underwent USPCNIN within 24 h of study enrollment by an attending chest wall surgeon. Primary outcomes were changes in daily narcotic use and numeric pain score from pre-intervention up to 30-day follow-up visits. Additional outcomes included hospital length of stay, procedure-related adverse events, and rib-specific readmission.
RESULTS: Fifteen patients were identified. Median (IQR) patient age was 52 (43, 58) years and four (27 %) were female. Median (IQR) number of rib fractures was 5 (4, 8). Median (IQR) hospital length of stay was 4 (3, 7) days. Daily opioid use (measured in morphine milligram equivalents, MME) and present pain intensity (PPI) decreased significantly from pre-intervention to hospital discharge (median MME 96.5 vs. 49.5, p = 0.043; median PPI 10 vs. 7, p = 0.020). Twelve patients completed 30-day follow-up and had significantly decreased MME and PPI from hospital discharge (median MME 62.3 vs. 5, p = 0.014; median PPI 6.5 vs. 3, p = 0.001). There were no complications directly attributable to the procedure. There were no rib-specific readmissions.
CONCLUSION: USPCNIN is a minimally-invasive, bedside procedure that can be safely performed by trauma surgeons and augment pain control for acute traumatic rib fractures.
METHODS: This was a single-institution case series. Patients between 18-64 years of age who sustained traumatic rib fracture between ribs 3-9, deemed ineligible for surgical stabilization, and had pre-procedure numeric pain scores ≥5 underwent USPCNIN within 24 h of study enrollment by an attending chest wall surgeon. Primary outcomes were changes in daily narcotic use and numeric pain score from pre-intervention up to 30-day follow-up visits. Additional outcomes included hospital length of stay, procedure-related adverse events, and rib-specific readmission.
RESULTS: Fifteen patients were identified. Median (IQR) patient age was 52 (43, 58) years and four (27 %) were female. Median (IQR) number of rib fractures was 5 (4, 8). Median (IQR) hospital length of stay was 4 (3, 7) days. Daily opioid use (measured in morphine milligram equivalents, MME) and present pain intensity (PPI) decreased significantly from pre-intervention to hospital discharge (median MME 96.5 vs. 49.5, p = 0.043; median PPI 10 vs. 7, p = 0.020). Twelve patients completed 30-day follow-up and had significantly decreased MME and PPI from hospital discharge (median MME 62.3 vs. 5, p = 0.014; median PPI 6.5 vs. 3, p = 0.001). There were no complications directly attributable to the procedure. There were no rib-specific readmissions.
CONCLUSION: USPCNIN is a minimally-invasive, bedside procedure that can be safely performed by trauma surgeons and augment pain control for acute traumatic rib fractures.