Percutaneous Cryoneurolysis of Intercostal Nerves Is Effective Pain Control for Rib Fracture in Older Adults

Wang S, Earley M, Kesselman A, et al. Percutaneous Cryoneurolysis for Pain Control After Rib Fractures in Older Adults. JAMA Surg. 2024.

Adequate pain control is an essential component of rib fracture management. Analgesic protocols used in older patients who are not candidates for surgical stabilization of multiple rib fractures include analgesic drugs, topical anesthetics, and percutaneous nerve blocks.

This article reported the results of adding percutaneous cryoneurolysis of intercostal nerves (PCNIN) to a conventional analgesic protocol.

The authors reported outcomes in 38 patients (complete 30-day follow-up in 31 patients) older than 65 years with multiple fractures of ribs 3–9. Pre-treatment pain scores were 5 or higher. CT guided percutaneous cryoneurolysis of intercostal nerves (PCNIN) was used; this intervention uses imaging-guided percutaneous application of nitrogen gas to an intercostal nerve to produce hypothermia resulting in temporary ablation. Analgesia is produced that lasts for 4–6 weeks followed by complete recovery of nerve function.

The data showed that patients treated with PCNIN had significant reductions in pain scores and required no additional pain control interventions. No adverse treatment-related events were reported.

The authors concluded that PCNIN was a safe and effective addition to conventional analgesic protocols for management of pain due to multiple rib fractures.