Salan-Gomez Marcelo, Fernandez Ramiro, D'Silva Ethan, Camarena Belia, Hills Emma, Leon Andres, Peer Syed B, Elsenousi Abdussalam, Garcha Puneet, Loor Gabriel
Division of Cardiothoracic Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
Section of Pulmonary and Critical Care Medicine, Department of Medicine, Baylor College of Medicine, Houston, Tex.
JTCVS Open. 2024 Oct 26;23:328-334. doi: 10.1016/j.xjon.2024.10.013. eCollection 2025 Feb.
Achieving adequate pain control after lung transplantation is an essential milestone in a patient's recovery. We compared postoperative opioid use, clinical outcomes, and respiratory function in lung transplant recipients treated with intercostal nerve cryoablation (INC) compared to those receiving standard pain management.
We reviewed all adult lung transplants performed at our center between January 2016 and December 2022. We excluded cases performed through median sternotomy and patients with prior thoracotomies, multiorgan transplants, and redo transplants. We performed a propensity score-matched analysis, comparing patients who received INC versus those who received standard pain management. The primary outcome was cumulative postoperative opioid use in morphine milligram equivalents (MME) by postoperative day (POD) 14. Secondary outcomes included opioid use on POD5 and POD10, perioperative outcomes, 1-year survival, and longitudinal measurement of respiratory function.
Propensity score matching resulted in 85 patients in each group. Compared to the standard pain management group, the INC group had a lower cumulative opioid use by POD14 (509 MME vs 864 MME; = .032). In addition, the INC group had less opioid use at POD5, POD10, and POD14; no difference in perioperative outcomes; and similar 1-year survival. The INC group had better respiratory function at 6 and 12 months post-transplant compared to the standard pain management group.
In our single-center analysis, INC was associated with less opioid use and improved respiratory function after lung transplant. This report adds to the growing literature supporting the use of INC in multimodal pain management strategies and enhanced recovery protocols in lung transplant.
肺移植术后实现充分的疼痛控制是患者康复的一个重要里程碑。我们比较了接受肋间神经冷冻消融术（INC）治疗的肺移植受者与接受标准疼痛管理的受者的术后阿片类药物使用情况、临床结局和呼吸功能。
我们回顾了2016年1月至2022年12月在本中心进行的所有成人肺移植手术。我们排除了通过正中胸骨切开术进行的病例以及有既往开胸手术史、多器官移植和再次移植的患者。我们进行了倾向评分匹配分析，比较接受INC的患者与接受标准疼痛管理的患者。主要结局是术后第14天以吗啡毫克当量（MME）计算的术后累积阿片类药物使用量。次要结局包括术后第5天和第10天的阿片类药物使用情况、围手术期结局、1年生存率以及呼吸功能的纵向测量。
倾向评分匹配后每组有85例患者。与标准疼痛管理组相比，INC组术后第14天的累积阿片类药物使用量较低（509 MME对864 MME；P = 0.032）。此外，INC组在术后第5天、第10天和第14天的阿片类药物使用量较少；围手术期结局无差异；1年生存率相似。与标准疼痛管理组相比，INC组在移植后6个月和12个月时呼吸功能更好。
在我们的单中心分析中，INC与肺移植后较少的阿片类药物使用和改善的呼吸功能相关。本报告增加了越来越多支持在肺移植的多模式疼痛管理策略和强化康复方案中使用INC的文献。
