Forrester Joseph D, Wang Simeng, Myers Alexandra A, Earley Michelle, Guthrie-Baker Sydney, Abreo Anisha, Knight Ariel W, Tung Jamie
Division of General Surgery, Department of Surgery, Stanford University, USA.
Injury. 2025 May;56(5):112321. doi: 10.1016/j.injury.2025.112321. Epub 2025 Apr 9.
Multimodal pain control is the cornerstone of managing acute traumatic rib fractures. We employed surgeon-administered, ultrasound-guided percutaneous cryoneurolysis of intercostal nerves (USPCNIN) as an adjunct opioid-sparing analgesic modality at the bedside.
This was a single-institution case series. Patients between 18-64 years of age who sustained traumatic rib fracture between ribs 3-9, deemed ineligible for surgical stabilization, and had pre-procedure numeric pain scores ≥5 underwent USPCNIN within 24 h of study enrollment by an attending chest wall surgeon. Primary outcomes were changes in daily narcotic use and numeric pain score from pre-intervention up to 30-day follow-up visits. Additional outcomes included hospital length of stay, procedure-related adverse events, and rib-specific readmission.
Fifteen patients were identified. Median (IQR) patient age was 52 (43, 58) years and four (27 %) were female. Median (IQR) number of rib fractures was 5 (4, 8). Median (IQR) hospital length of stay was 4 (3, 7) days. Daily opioid use (measured in morphine milligram equivalents, MME) and present pain intensity (PPI) decreased significantly from pre-intervention to hospital discharge (median MME 96.5 vs. 49.5, p = 0.043; median PPI 10 vs. 7, p = 0.020). Twelve patients completed 30-day follow-up and had significantly decreased MME and PPI from hospital discharge (median MME 62.3 vs. 5, p = 0.014; median PPI 6.5 vs. 3, p = 0.001). There were no complications directly attributable to the procedure. There were no rib-specific readmissions.
USPCNIN is a minimally-invasive, bedside procedure that can be safely performed by trauma surgeons and augment pain control for acute traumatic rib fractures.
多模式疼痛控制是急性创伤性肋骨骨折治疗的基石。我们采用外科医生实施的、超声引导下肋间神经经皮冷冻神经lysis术（USPCNIN）作为一种辅助的阿片类药物节省镇痛方式，在床边进行。
这是一个单机构病例系列。年龄在18 - 64岁之间、肋骨3 - 9处发生创伤性肋骨骨折、被认为不适合手术固定且术前数字疼痛评分≥5的患者，在研究入组后24小时内由胸壁主治外科医生进行USPCNIN。主要结局是从干预前到30天随访期间每日麻醉药物使用量和数字疼痛评分的变化。其他结局包括住院时间、与手术相关的不良事件以及肋骨特异性再入院情况。
共纳入15例患者。患者年龄中位数（四分位间距）为52（43，58）岁，4例（27%）为女性。肋骨骨折数量中位数（四分位间距）为5（4，8）根。住院时间中位数（四分位间距）为4（3，7）天。从干预前到出院，每日阿片类药物使用量（以吗啡毫克当量，MME衡量）和当前疼痛强度（PPI）显著降低（MME中位数96.5对49.5，p = 0.043；PPI中位数10对7，p = 0.020）。12例患者完成了30天随访，出院后MME和PPI显著降低（MME中位数62.3对5，p = 0.014；PPI中位数6.5对3，p = 0.001）。没有直接归因于该手术的并发症。没有肋骨特异性再入院情况。
USPCNIN是一种微创的床边手术，创伤外科医生可以安全地实施，并且可以增强对急性创伤性肋骨骨折的疼痛控制。
