Intraoperative Cryoanalgesia and Oral Opioid Requirements after Lung Transplantation

Abstract

Over 50% of those entering substance treatment programs were first exposed to opioids through a prescription. Among the opioid naïve, surgery is the 2nd most common indication for opioid prescriptions. Lung transplant recipients require long term opioids at significantly higher rates than other surgical patients. We undertook this study to define effects of cryoanalgesia (CRYO) on opioid use. We conducted a two period observational study of lung transplant inpatient oral opioid use from June 2015 to September 2018, comparing two pain management strategies: CRYO and standard care (SOC). In August 2017 CRYO was added to SOC pain management protocols. Patients were pseudorandomized to SOC with and without CRYO based on call day. Prior to implantation, the intercostal nerves were identified and ablated at 4 levels (one above through two below space of entry). Secondary analyses of pain perception (0-10) and Richmond Agitation and Sedation Scale were also performed. Data were abstracted from the electronic health record of all patients during their index admission. The four groups of patients (2 periods cross classified with intervention) were then standardized through weighted longitudinal models to balance patients' characteristics and reduce confounding. CRYO added to SOC pain management strategies reduced oral opioid requirements substantially but not significantly in the 1st week and significantly and by more than 50% in the 2nd and 3rd post-operative weeks, respectively (Fig. 1a). Maximal perception of pain on the numeric rating scale was reduced in the CRYO group compared to the control group by 1.04 [0.29;1.78], 0.95 [.05; 1.93] and 1.03 [0.03; 2.11] (Fig. 1b). No effects were noted in agitation and sedation measures. Addition of CRYO to standard multimodality post-operative pain treatment regimens was associated with decreased oral opioid requirements and reduction in maximal pain perception. No effect was observed in agitation or sedation measures.