Intercostal nerve cryoablation therapy in thoracic and cardiac surgery for postoperative pain management: a systematic review and meta-analysis

Objectives Thoracic and cardiac surgical procedures are associated with significant postoperative pain. Intercostal nerve cryoablation (INC) is a non-opioid adjunctive pain management strategy. The objective of this study was to comprehensively review published outcomes of INC during non-pectus repair thoracic and cardiac surgeries to inform clinical practice and guideline development. Methods A literature search was conducted in PubMed, Embase, Google Scholar, and using manual approaches to identify comparative studies of patients undergoing non-pectus repair thoracic or cardiac procedures with INC versus standard of care (SOC) without INC. Meta-analyses were performed to quantitively evaluate opioid consumption and hospital length of stay (LOS). Secondary outcomes were summarized qualitatively. Results Twenty-four studies were included encompassing 18,465 patients, of whom 10.6% (n = 1,954) received INC. INC was applied during surgical stabilization of rib fractures, thoracotomy, pulmonary resections, lung transplants, aortic aneurysm repair, and cardiac procedures. Meta-analyses of adult studies demonstrated a significant reduction in inpatient opioid consumption by 102 morphine milligram equivalents (MME) (95% confidence interval [CI]: -180.00, -23.87) and a non-significant reduction in opioid consumption after discharge by 89 MME (95% CI: -182.00, 4.56) with INC. Sub-group analysis demonstrated the largest effect size in inpatient opioid reduction for bilateral thoracotomy or thoracosternotomy for lung transplants. Meta-analysis demonstrated no significant difference in hospital stay for adult patients treated with INC. Conclusion The results of this systematic review and meta-analysis provide evidence to support the association between INC and reduced inpatient opioid consumption in non-pectus repair thoracic and cardiac procedures.