Finneran John J, Kobayashi Leslie, Costantini Todd W, Weaver Jessica L, Berndtson Allison E, Haines Laura, Doucet Jay J, Adams Laura, Santorelli Jarrett E, Lee Jeanne, Trescot Andrea M, Donohue Michael C, Schaar Adam, Ilfeld Brian M
Department of Anesthesiology, University of California-San Diego, La Jolla, California; Outcomes Research Consortium, University of Texas-Houston, Houston, Texas.
Department of Surgery, University of California-San Diego, La Jolla, California.
Anesthesiology. 2025 Mar 1;142(3):532-545. doi: 10.1097/ALN.0000000000005328. Epub 2024 Dec 19.
Traumatic rib fractures are associated with pain lasting weeks to months and a decreased ability to inspire deeply or cough to clear secretions. Ultrasound-guided percutaneous cryoneurolysis involves reversibly ablating peripheral nerve(s) using exceptionally low temperature with a transdermal probe, resulting in a prolonged nerve block with a duration measured in months. The authors hypothesized that cryoneurolysis would improve analgesia and inspired volume after rib fracture.
Adults with one to six traumatic rib fractures were randomized to either active cryoneurolysis and sham peripheral nerve block or sham cryoneurolysis and active peripheral nerve block in a participant/observer-masked fashion. The primary endpoint was the maximum inspired volume the day after the procedure as measured with an incentive spirometer.
The day after the procedure, the unadjusted median [interquartile range] maximum inspired volume for participants who received cryoneurolysis (n = 11) was 2,250 ml [1,500, 2,500 ml] versus 1,300 ml [750, 2,500 ml] for peripheral nerve block (n = 9, mean difference, 496; 95% CI, -428 to 1,420; t test P = 0.269). When adjusted for covariates ( e.g. , baseline lung volume), the cryoneurolysis group had an estimated 793 ml greater mean volume than peripheral nerve block (95% CI, 273 to 1,312 ml; analysis of covariance P = 0.005). Improvement from baseline in maximum inspired volume for cryoneurolysis was 1,000 ml [1,000, 1,375 ml] versus 300 ml [0, 1,000 ml] for peripheral nerve block ( t test P = 0.002). This was equivalent to an improvement over baseline of 100% [90%, 188%] for cryoneurolysis versus 30% [0%, 50%] for peripheral nerve block ( t test P = 0.003). Average daily pain scores were generally lower for the cryoneurolysis group throughout the first month. Total cumulative oxycodone equivalents were 5 mg [0, 13 mg] for cryoneurolysis versus 45 mg [43, 135 mg] for peripheral nerve block ( t test P = 0.013).
Ultrasound-guided percutaneous cryoneurolysis improves maximum inspired lung volume while concurrently decreasing pain and opioid consumption after traumatic rib fracture. These results should be considered preliminary, requiring confirmation with a trial including a larger sample size.
创伤性肋骨骨折会导致持续数周甚至数月的疼痛，同时深呼吸或咳嗽以清除分泌物的能力也会下降。超声引导下经皮冷冻神经lysis术是使用经皮探头通过极低温度可逆地消融外周神经，从而产生持续数月的长时间神经阻滞。作者推测冷冻神经lysis术可改善肋骨骨折后的镇痛效果和吸气量。
将患有1至6根创伤性肋骨骨折的成年人以参与者/观察者双盲的方式随机分为接受主动冷冻神经lysis术和假外周神经阻滞组，或假冷冻神经lysis术和主动外周神经阻滞组。主要终点是术后第二天用激励肺活量计测量的最大吸气量。
术后第二天，接受冷冻神经lysis术的参与者（n = 11）未经调整的最大吸气量中位数[四分位间距]为2250毫升[1500, 2500毫升]，而接受外周神经阻滞的参与者（n = 9）为1300毫升[750, 2500毫升]，平均差异为496；95%置信区间为-428至1420；t检验P = 0.269。在对协变量（如基线肺容量）进行调整后，冷冻神经lysis术组的平均吸气量估计比外周神经阻滞组多793毫升（95%置信区间为273至1312毫升；协方差分析P = 0.005）。冷冻神经lysis术组术后最大吸气量较基线的改善为1000毫升[1000, 1375毫升]，而外周神经阻滞组为300毫升[0, 1000毫升]（t检验P = 0.002）。这相当于冷冻神经lysis术组较基线改善了100%[90%, 188%]，而外周神经阻滞组为30%[0%, 50%]（t检验P = 0.003）。在第一个月内，冷冻神经lysis术组的平均每日疼痛评分总体上较低。冷冻神经lysis术组的羟考酮等效物总累积量为5毫克[0, 13毫克]，而外周神经阻滞组为45毫克[43, 135毫克]（t检验P = 0.013）。
超声引导下经皮冷冻神经lysis术可改善创伤性肋骨骨折后的最大吸气肺容量，同时减轻疼痛并减少阿片类药物的消耗。这些结果应被视为初步结果，需要通过更大样本量的试验进行验证。
