Cryoanalgesia in the management of pain after thoracotomy

ABSTRACT The demand for postoperative analgesia was compared between 29 patients treated with cryoanalgesia to the relevant intercostal nerves during thoracotomy and a control group who did not have cryoanalgesia. The cryoanalgesia group required significantly less (p <0 005) postoperative analgesia than did the control group. Thoracotomy is generally considered to give rise to a painful surgical wound ' and in addition the procedure is associated with a high incidence of postoperative pulmonary complications.2 It has been suggested that there is a decrease in the incidence of pulmonary complications after extradural analgesia.3 Although an excellent method for achieving analgesia, thoracic extradural analgesia is a technique for the expert who has adequate nursing support and the correct environment.4 5 Alternative methods for relieving pain after thoracotomy include the use of narcotic analgesics and the block of relevant intercostal nerves with local analgesics.6 The longest acting agent commercially available is bupivacaine (Mar-cain) which has been reported to give analgesia for between nine and 18 hours.7 The injections may be performed by adequately trained junior medical staff, but there is a risk of creating a pneumothorax and the injections may have to be repeated several times. The problem may be overcome by the use of cryoanalgesia which gives a median duration of pain relief of 26 days after treatment with the cryoprobe.8 In this study, 29 patients undergoing thoracic operations had a cryoprobe applied to the relevant intercostal nerves at the time of operation and the results were compared with a control group. Patients and methods The 29 patients in this study comprised 25 men and four women with a mean age of 60 years (range 19-75 yr). The diagnoses, confirmed at operation, were cancer of the lung (21), cancer of the stomach (three), spontaneous pneumothorax (two), lung abscess (two), hiatus hernia (one). The operations performed were 17 right postero