Authors: Jew M et al.
BMJ Journals Regional Anesthesia & Pain Medicine
Summary
This technical report and case series describes the use of ultrasound-guided, percutaneous cryoneurolysis of the intercostal nerves as an analgesic strategy for high-risk patients with traumatic rib fractures. Rib fractures in medically fragile patients often lead to severe pain, impaired ventilation, increased pulmonary complications, and prolonged hospitalization. Traditional approaches—opioids, epidurals, and paravertebral catheters—carry limitations such as short duration, medication side effects, and procedural risks.
Cryoneurolysis provides long-lasting analgesia by temporarily disrupting nerve conduction through controlled freezing of the nerve. Because rib fracture pain persists for weeks, cryoneurolysis aligns well with the natural healing timeline, offering a key advantage over shorter-duration techniques.
The authors present five high-risk patients—each with a Rib Fracture Score >6 and a STUMBL Score ≥26—who underwent ultrasound-guided intercostal cryoneurolysis. After treatment, all patients demonstrated meaningful clinical improvement: better pain control, reduced opioid requirements, improved oxygenation with rapid weaning from supplemental oxygen, and accelerated mobilization toward discharge readiness.
The report highlights the technique’s practicality: ultrasound guidance aids precise nerve localization and ensures safe probe placement. No major complications were reported. The authors suggest that cryoneurolysis may fill an important gap in rib-fracture pain management, offering sustained analgesia with a favorable safety and logistical profile.
What You Should Know
• Cryoneurolysis provides long-lasting analgesia that matches the prolonged pain course of rib fractures.
• Five high-risk trauma patients received ultrasound-guided intercostal cryoneurolysis.
• All patients experienced improved pain scores and reduced opioid needs.
• Respiratory status improved, allowing faster oxygen weaning.
• Mobilization and rehabilitation progressed more rapidly.
• The technique appears safe, minimally invasive, and well suited for severe rib-fracture pain.
Thank you BMJ Journals Regional Anesthesia & Pain Medicine for allowing us to use this article.