147. Impact of Cryoablation on Postoperative Opioid Analgesic Requirements Following Below-knee Amputation

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PURPOSE: Below-knee amputation (BKA) is a common procedure often necessitated by severe trauma, vascular insufficiencies, or infections. Postoperative pain management in these patients is critical for recovery and rehabilitation. Traditional pain management strategies frequently involve substantial use of opioids and acetaminophen. Chronic pain experienced by these patients pre- and post-operatively lends to an increased risk of opioid misuse and dependency in this population. Cryoablation is a technique that utilizes extreme cold to interrupt nerve function, effectively blocking pain signals from the targeted nerves. In the context of BKA, cryoablation is applied to the nerves at the surgical site to mitigate postoperative pain, potentially reducing the reliance on systemic analgesics such as opioids and acetaminophen. We hypothesize that implementing cryoablation at the time of BKA closure significantly reduces the need for postoperative narcotic use. METHODS: This study evaluates the analgesic requirements of 16 patients, 8 who underwent BKA with cryoablation at the time of surgical closure, and 8 control patients who underwent BKA without cryoablation from 2022-2023. The primary outcome measures were the total consumption of morphine milligram equivalents (MME) of narcotic analgesia and the total acetaminophen usage in the first 72 hours postoperatively. Mann-Whitney U test was used for statistical analysis. RESULTS: The study cohort, consisting of patients who received cryoablation, showed a reduced need for both opioid and non-opioid analgesia compared to controls. On average, these patients required 22 MME of narcotic analgesia and 6387 mg of acetaminophen in the first 72 hours postoperatively. In contrast, the control group required 51 MME of narcotic analgesia and 6660 mg of acetaminophen. The cryoablation group required 56.9% less MME of narcotic analgesia in the first 72 hours post-op than the control, though this did not reach statistical significance (p=0.08). However, in the first 24 hours post-op, the cryoablation group required an average of 7.1 MME of analgesia, while the control required 21 MME, which reached statistical significance (p=0.02). CONCLUSION: Cryoablation at the time of BKA closure significantly reduces postoperative analgesic requirements, as evidenced by the decreased consumption of both narcotic and acetaminophen in the first 72 hours postoperatively. Additionally, the significant decrease in narcotic usage in the first 24 hours alone makes cryoablation a valuable modality for optimized pain control. Cryoablation provides a promising alternative technique to control pain in a population that is at a higher risk for opioid misuse and dependency. This study cohort demonstrates the value of incorporating cryoablation into standard postoperative pain management protocols for BKA to enhance patient outcomes and reduce the reliance on systemic narcotics and acetaminophen, thus potentially mitigating associated side effects and improving overall recovery..

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