Clinical Outcomes of Cryo Nerve Ablation Technique for Pain Management: An Exploratory Study in Patients Undergoing Left Thoracotomy Coronary Artery Bypass Grafting

Aleksander Dokollari^1,*, Serge Sicouri¹, Ozgun Erten¹, Basel Ramlawi^1,2, Matteo Cameli³, Giulia Elena Mandoli³, Beatrice Bacchi⁴, Francesco Cabrucci⁴, Francis P. Sutter², Stephanie Kjelstrom⁵, Georgia Montone⁵, Noah Sicouri², Leila Hosseinian^2,†, Massimo Bonacchi^4,†, Gianluca Torregrossa^1,2,†

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¹ Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 3450, USA

² Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, PA 3450, USA

³ Department of Cardiology, Le Scotte Hospital, University of Siena, 53100 Siena, Italy

⁴ F.U. of Cardiac Surgery, Department of Experimental and Clinical Medicine - University of Florence, 50134 Firenze, Italy

⁵ Department of Cardiac Surgery, Population Health, Lankenau Institute for Medical Research, Wynnewood, PA 3450, USA

^*Correspondence: aleksanderdokollari2@gmail.com (Aleksander Dokollari)
^†These authors contributed equally.

Rev. Cardiovasc. Med. 2023, 24(6), 182; https://doi.org/10.31083/j.rcm2406182

Submitted: 26 January 2023 | Revised: 25 April 2023 | Accepted: 6 May 2023 | Published: 25 June 2023

This is an open access article under the CC BY 4.0 license.

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Abstract

Background: To investigate the impact of Cryo Nerve Block with cryoICE™ device utilization, on post-operative pain in patients undergoing isolated coronary artery bypass grafting (CABG) through left thoracotomy. Methods: All consecutive patients undergoing isolated CABG through left thoracotomy between July 2021 and July 2022 from a single surgeon were included in the study. Patients using the cryoICE™ device for nerve block were compared for baseline demographics and pre-operative characteristics with those that did not use the cryoICE™ device. A propensity-adjusted analysis was used to compare the two groups. The primary outcome was degree of incisional pain and numbness. Results: A total of 103 patients underwent isolated CABG through left thoracotomy. After matching, the cryoICE™ device was used for nerve block in 60 patients while the control group included 43 patients. Mean follow-up was 5.7 months. The cryoICE™ device group had a mean value of incisional pain at hospital discharge was 1.5 (scale 0–10) while at follow-up was 0.69 (scale 0–10). Mean values of skin numbness at hospital discharge were 1 (scale 0–10) and 0.57 (scale 0–10) at follow-up. After univariate analysis comparison of cryoICE™ device group (60 patients) versus non-cryoICE™ device group (43 patients), the total in-hospital morphine use was 49% lower in the cryoICE™ versus the non-cryoICE™ cohort (73.8 + 79.37 mg vs 144.1 + 118.99 mg). Conclusions: Good clinical outcomes were observed in patients undergoing isolated left thoracotomy CABG with cryoICE™ utilization, including a very low incidence of post-operative pain, numbness, and hypersensitivity for all comers.

Keywords

cryoICE™

Cryo Nerve Block

pain

numbness

sensitivity

opioids

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Funding

SSRF2022-10/Sharpe - Strumia Research Foundation

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Rev. Cardiovasc. Med. Print ISSN 1530-6550 Electronic ISSN 2153-8174