Intercostal nerves cryoanalgesia and open thoracotomy for major lung resection: evaluation of perioperative outcomes and medico-economic analysis.

BACKGROUND

Thoracotomy is still required for major lung resections, though minimally invasive approaches are increasing. Postoperative pain and respiratory issues remain challenges, and current analgesia like epidurals have limitations. Intercostal nerves cryoanalgesia has emerged as a promising alternative, but its clinical and economic impact in thoracotomy remains underexplored.

MATERIALS AND

METHODS

We conducted a retrospective, observational, single-center study comparing two groups: a standard of care group (SOC, n = 54) and a cryoanalgesia group (CRYO, n = 29). All patients underwent thoracotomy with major lung resection. The CRYO group additionally received intercostal nerves cryoanalgesia. We analyzed postoperative complications, pain levels, ICU and hospital length of stay, morphine consumption, and direct hospitalization costs.

RESULTS

Cryoanalgesia significantly reduced overall postoperative complications (24.1 % vs 50.0 %, p = 0.034), particularly respiratory complications (10.3 % vs 37 %, p = 0.035). ICU stay was shorter in the CRYO group (2 (IQR = 1) vs 3 (IQR = 1) days, p = 0.001), while total hospital stay showed no significant difference. Pain scores and morphine use were similar in both groups. The cost analysis showed lower ICU-related costs in the CRYO group, as well as a financial benefit for the French public health system.

CONCLUSION

Intercostal nerves cryoanalgesia during thoracotomy is associated with reduced postoperative and respiratory complications and a shorter ICU stay, while pain levels remain similar. These benefits may improve patient outcomes and reduce ICU burden, suggesting a medico-economic benefit for cryoanalgesia in thoracic surgery.