Intercostal nerve cryoanalgesia in lung transplantation: a retrospective single-center study

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Background: Pain management after lung transplantation (LT) is challenging, with most cen-ters using a multimodal analgesia approach that includes opioids and thoracic epidural analge-sia (TEA). Intercostal nerve cryoanalgesia (INCA), which blocks peripheral nerves to provide pain control for about two months, is gaining popularity worldwide but has rarely been stud-ied in the context of LT. Methods: Retrospective, before-and-after single-center study conducted between October 2024 and July 2025. A group without INCA (PRE-INCA) was compared to a group with INCA (POST-INCA). All patients received TEA and multimodal analgesia. The primary out-come was the total consumption of oral morphine milligram equivalents (MMEs) between Day 1 and Day 28. Results: We included 28 consecutive LT recipients, among whom 14 received INCA. Pa-tients' baseline characteristics were similar across groups. Patients in the POST-INCA group received significantly fewer opioids during the first 28 days (PRE-INCA 1,499 [972, 1,909] MME vs. POST-INCA 543 [153, 1,050] MME; P = 0.004). Moreover, at month 1, basal pain was significantly reduced in the POST-INCA group (Numeric Rating Scale [NRS] PRE-INCA 2.25 [0.00, 4.50] vs. NRS POST-INCA 0.00 [0.00, 0.00]; P = 0.010). Other clinical outcomes, including duration of mechanical ventilation, length of stay, forced expiratory value at 1 s, and mortality, were similar between the groups. Conclusions: Adding INCA to TEA is associated with a significant reduction in opioid con-sumption and postoperative pain during the first 28 days following LT. These results should be interpreted with caution due to the retrospective, single-center design and the small sample size of the study.

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