Cha Peter I, Min Jung Gi, Patil Advait, Choi Jeff, Kothary Nishita N, Forrester Joseph D
Department of Surgery, Stanford University, Stanford, CA, USA.
Stanford University School of Medicine, Stanford, California, USA.
Trauma Surg Acute Care Open. 2021 May 18;6(1):e000690. doi: 10.1136/tsaco-2021-000690. eCollection 2021.
There is a critical need for non-narcotic analgesic adjuncts in the treatment of thoracic pain. We evaluated the efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain, specifically addressing the applicability of intercostal cryoneurolysis for pain control after chest wall trauma.
A systematic review was performed through searches of PubMed, EMBASE, and the Cochrane Library. We included studies involving patients of all ages that evaluated the efficacy of intercostal cryoneurolysis as a pain adjunct for chest wall pathology. Quantitative and qualitative synthesis was performed.
Twenty-three studies including 570 patients undergoing cryoneurolysis met eligibility criteria for quantitative analysis. Five subgroups of patients treated with intercostal cryoneurolysis were identified: pectus excavatum (nine studies); thoracotomy (eight studies); post-thoracotomy pain syndrome (three studies); malignant chest wall pain (two studies); and traumatic rib fractures (one study). There is overall low-quality evidence supporting intercostal cryoneurolysis as an analgesic adjunct for chest wall pain. A majority of studies demonstrated decreased inpatient narcotic use with intercostal cryoneurolysis compared with conventional pain modalities. Intercostal cryoneurolysis may also lead to decreased hospital length of stay. The procedure did not definitively increase operative time, and risk of complications was low.
Given the favorable risk-to-benefit profile, both percutaneous and thoracoscopic intercostal cryoneurolysis may serve as a worthwhile analgesic adjunct in trauma patients with rib fractures who have failed conventional medical management. However, further prospective studies are needed to improve quality of evidence.
Level IV systematic reviews and meta-analyses.
在胸痛治疗中，对非麻醉性镇痛辅助药物有着迫切需求。我们评估了肋间冷冻神经lysis术作为胸壁疼痛镇痛辅助手段的疗效，特别探讨了肋间冷冻神经lysis术在胸壁创伤后疼痛控制中的适用性。
通过检索PubMed、EMBASE和Cochrane图书馆进行系统评价。我们纳入了涉及各年龄段患者的研究，这些研究评估了肋间冷冻神经lysis术作为胸壁病变疼痛辅助手段的疗效。进行了定量和定性综合分析。
23项研究共570例接受冷冻神经lysis术的患者符合定量分析的纳入标准。确定了接受肋间冷冻神经lysis术治疗的五个患者亚组：漏斗胸（9项研究）；开胸手术（8项研究）；开胸术后疼痛综合征（3项研究）；恶性胸壁疼痛（2项研究）；以及创伤性肋骨骨折（1项研究）。总体而言，支持肋间冷冻神经lysis术作为胸壁疼痛镇痛辅助手段的证据质量较低。与传统疼痛治疗方式相比，大多数研究表明肋间冷冻神经lysis术可减少住院患者的麻醉药物使用。肋间冷冻神经lysis术还可能缩短住院时间。该手术并未明确增加手术时间，并发症风险较低。
鉴于其良好的风险效益比，经皮和胸腔镜下肋间冷冻神经lysis术对于传统药物治疗无效的肋骨骨折创伤患者可能是一种值得采用的镇痛辅助手段。然而，需要进一步的前瞻性研究来提高证据质量。
IV级系统评价和荟萃分析。
