Intercostal Nerve Cryoablation and Pain Outcomes in Robotic Lung Surgery

Background: Pain after robot-assisted thoracoscopic lung surgery is a contributing factor to postoperative complications and patient satisfaction. Cryoablation of the intercostal nerves temporarily disrupts nerve function and decreases pain. We evaluated the effect of cryoablation of the intercostal nerves on postoperative pain and opioid use. Methods: We performed a retrospective single-institution analysis of patients who underwent robot-assisted thoracoscopic lung surgery, with or without cryoablation between 2019 and 2022. We analyzed demographics, postoperative pain scores using a Likert scale, opioid use, postoperative complications, length of stay, and readmission. Results: Robot-assisted thoracoscopic lung surgery was performed in 230 patients, and 39 (17%) patients underwent cryoablation. Pain scores for the cryoablation group were lower at 12 hours (0 vs 2, P =. 04) and higher at 5 weeks (4 vs 1, P =. 01). The cryoablation group was more likely to receive an opioid prescription (46.2% vs 29.3%, P =. 04) and a higher reported use of narcotics at 5 weeks (61.5% vs 37.7%, P <. 01). There were no statistical differences in postoperative morphine milliequivalents per day, minor and major complication rates, total length of hospital stay, and readmission rates. Conclusions: Cryoablation of multilevel intercostal nerves has higher pain levels at 5 weeks without significant differences in the outcomes. This may be due to an increase in neuroma formation at multiple levels from the cryoablation.