Intraoperative intercostal nerve cryoablation vs. patient-controlled analgesia after thoracotomy: a single-center retrospective cohort study demonstrating comparable early pain and opioid use.

BACKGROUND AND AIMS: Thoracotomy is among the most painful surgical procedures and is associated with a high risk of chronic postoperative pain. Optimizing perioperative analgesia is essential for enhancing recovery and reducing opioid-related side effects. This study evaluated whether adding intraoperative intercostal nerve cryoablation to standard postoperative analgesia improves pain control and reduces opioid use following thoracotomy.

MATERIALS AND

METHODS

This retrospective cohort study included patients who underwent thoracotomy at a tertiary cancer center in 2024. Patients receiving intraoperative intercostal nerve cryoablation in addition to standard postoperative analgesia (n = 32) were compared with patients receiving standard postoperative analgesia alone (n = 33). Primary outcomes were pain scores at multiple postoperative intervals and opioid usage, converted into morphine milligram equivalents (MME).

RESULTS

Baseline demographics were comparable between groups. Mean pain scores did not differ significantly at 30 min (2.3 vs. 2.3; p = 0.97), Day 1 (2.9 vs. 2.9; p = 0.40), or Day 2 (2.9 vs. 2.9; p = 0.99). Opioid requirements were also similar on Day 1 (14.8 vs. 13.9 mg MME, p = 0.56) and Day 2 (17.7 vs. 20.6 mg MME, p = 0.22). On Day 3, statistical comparison was not applicable due to PCA discontinuation, though mean opioid use was comparable. Female patients reported higher Day 1 pain scores (3.0 vs. 2.8; p = 0.03), without differences in opioid consumption.

CONCLUSIONS

The addition of intercostal nerve cryoablation was not associated with improved postoperative pain control or reduced opioid use. These findings support cryoablation as a feasible component of multimodal analgesia after thoracotomy. Larger prospective trials with long-term follow-up are warranted to clarify its role in thoracic enhanced recovery pathways.