Cryoanalgesia Reduces Postoperative Pneumonia in Patients Undergoing Double Lung Transplantation Compared to Thoracic Paravertebral Catheters and Traditional Opiate Based Analgesia

Purpose Postoperative pain for bilateral lung transplant patients is often poorly controlled and may negatively impact recovery. Intercostal cryoanalgesia (IC-CRYO) may provide an additional modality to pain control. We hypothesize that IC-CRYO may enhance recovery compared to traditional opiate based analgesia (OBA) and thoracic paravertebral catheter (TPVC) analgesia. Methods Consecutive patients from January 2015 to May 2019 receiving a double lung transplant were included in this retrospective review. Pediatric age, single lung and redo lung transplants were excluded. TPCV group received 4 bilateral catheters at T4 and T8 levels postoperatively in the intensive care unit. IC-CRYO was performed intraoperatively by the surgeon from intercostal nerves 3-7 bilaterally. Results A total of 66 patients received IC-CRYO, 51 patients received OBA, and 89 received TPVC. The IC-CRYO group was significantly older (59 vs 52; p = 0.01) and had higher BMI (25.8 vs 24.2; p = 0.05) compared to OBA. Both the restrictive lung disease patients (62% IC-CRYO, 46% TPVC and 47% OBA) and the lung allocation scores (52 IC-CRYO, 47 TPVC and 51 OBA) were higher in IC-CRYO. There were no differences in time on the ventilator, ICU or hospital length of stay. There was a trend to lesser need for tracheostomy in IC-CRYO compared to OBA (5% vs 16%; p = value 0.06). IC-CRYO showed a significant decrease in post operative pneumonia compared to OBA (3% vs 22%; p = 0.03) and to TPVC (3% vs 17%; p = 0.03). There were no complications related to TPVC or IC-CRYO. Conclusion The present data suggest IC-CRYO and TPVC are effective as adjuncts to pain control for patients undergoing bilateral lung transplant. The data suggest IC-CRYO is strongly associated with functional improvements in patient recovery from bilateral lung transplant when compared with TPVC and OBA for postoperative pain control.