{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T02:30:07Z","timestamp":1784860207822,"version":"3.55.0"},"reference-count":21,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T00:00:00Z","timestamp":1724284800000},"content-version":"unspecified","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100020292","name":"Pacira BioSciences","doi-asserted-by":"publisher","award":["2020-0604"],"award-info":[{"award-number":["2020-0604"]}],"id":[{"id":"10.13039\/100020292","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020292","name":"Pacira BioSciences","doi-asserted-by":"publisher","award":["2021-031"],"award-info":[{"award-number":["2021-031"]}],"id":[{"id":"10.13039\/100020292","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2024,7,28]]},"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Acute pain due to rib fractures causes significant in-hospital morbidity and impacts patients\u2019 quality of life after discharge. Intraoperative transthoracic cryoneurolysis of the intercostal nerves can improve postoperative pain; however, non-surgical patients are provided limited analgesia options. Here, we describe our experience with a bedside cryoanalgesia technique for management of acute rib fracture pain.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Five patients at a single level I trauma center completed bedside intercostal nerve cryoneurolysis (INC) using a handheld cryotherapy device and ultrasound guidance. Relative pain ratings (scale 0\u201310\/10) and maximal incentive spirometry (IS<jats:sub>max<\/jats:sub>) volumes were taken prior to the procedure as a baseline. Patients were observed for 24 hours after procedure, with relative pain ratings and IS<jats:sub>max<\/jats:sub> recorded at 1, 8, 16, and 24 hours after procedure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Our patients were 29\u201388 years old and had one to five single-sided rib fractures. At baseline, they had high pre-procedure pain ratings (7\u201310\/10) and IS<jats:sub>max<\/jats:sub> volumes of 800\u20132000\u2009mL. Many had improvements in their pain rating but little change in their IS<jats:sub>max<\/jats:sub> at 1 hour (1\u20135\/10 and 1000\u20132000\u2009mL, respectively) and 8 hours (1\u20135\/10 and 1250\u20132400\u2009mL, respectively). IS<jats:sub>max<\/jats:sub> volumes improved by 16 hours (1500\u20132400\u2009mL) with comparable pain ratings (0\u20135\/10). At 24 hours, pain ratings and IS<jats:sub>max<\/jats:sub> ranged from 0 to 8\/10 and from 1500 mL to 2400\u2009mL, respectively. Each patient had improved pain control and IS<jats:sub>max<\/jats:sub> volumes compared with their pre-procedure values. All patients reported the procedure as an asset to their recovery at discharge.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our study demonstrates patients with rib fractures may experience improved pain ratings and IS<jats:sub>max<\/jats:sub> values after INC. Percutaneous INC appears to be a viable adjunct to multimodal pain control for patients with rib fractures and should be considered in patients with difficult pain control. Further studies are required to fully assess INC safety, efficacy, post-discharge outcomes, and utility in patients with altered mental status or on mechanical ventilation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence<\/jats:title>\n                  <jats:p>Level V, case series.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2024-001521","type":"journal-article","created":{"date-parts":[[2024,8,23]],"date-time":"2024-08-23T01:07:44Z","timestamp":1724375264000},"page":"e001521","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Bedside percutaneous cryoneurolysis technique for management of acute rib fracture pain in adult trauma patients"],"prefix":"10.1136","volume":"9","author":[{"given":"Cynthia I","family":"Villalta","sequence":"first","affiliation":[{"name":"Clinical Research Institute, Methodist Health System, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabiya K","family":"Mian","sequence":"additional","affiliation":[{"name":"Clinical Research Institute, Methodist Health System, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6658-311X","authenticated-orcid":false,"given":"Heather M","family":"Grossman Verner","sequence":"additional","affiliation":[{"name":"Clinical Research Institute, Methodist Health System, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Farsakh","sequence":"additional","affiliation":[{"name":"Clinical Research Institute, Methodist Health System, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy C","family":"Browne","sequence":"additional","affiliation":[{"name":"Department of Surgery, Methodist Dallas Medical Center, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary S","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Clinical Research Institute, Methodist Health System, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1522-2415","authenticated-orcid":false,"given":"Conner","family":"McDaniel","sequence":"additional","affiliation":[{"name":"Department of Surgery, Methodist Dallas Medical Center, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,8,22]]},"reference":[{"key":"2025081711022871000_9.1.e001521.1","doi-asserted-by":"crossref","first-page":"41","DOI":"10.21037\/jeccm.2018.04.03","article-title":"Management of severe chest wall trauma","volume":"2","author":"Saillant","year":"2018","journal-title":"J Emerg Crit Care Med"},{"key":"2025081711022871000_9.1.e001521.2","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1097\/TA.0000000000003623","article-title":"In-hospital outcomes of intercostal nerve cryoablation and surgical stabilization of rib fractures","volume":"93","author":"Fernandez","year":"2022","journal-title":"J Trauma Acute Care Surg"},{"key":"2025081711022871000_9.1.e001521.3","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199412000-00018"},{"key":"2025081711022871000_9.1.e001521.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2012.12.007"},{"key":"2025081711022871000_9.1.e001521.5","doi-asserted-by":"crossref","DOI":"10.1016\/j.tcr.2019.100229","article-title":"Intercostal nerve cryoablation for control of traumatic rib fracture pain: A case report","volume":"23","author":"Vossler","year":"2019","journal-title":"Trauma Case Rep"},{"key":"2025081711022871000_9.1.e001521.6","doi-asserted-by":"crossref","unstructured":"Marturano MN , Thakkar V , Wang H , Cunningham KW , Lauer C , Sachdev G , Ross SW , Jordan MM , Dieffenbaugher ST , Sing RF , et al . Intercostal nerve cryoablation during surgical stabilization of rib fractures decreases post-operative opioid use, ventilation days, and intensive care days. Injury 2023;54. doi:10.1016\/j.injury.2023.05.034","DOI":"10.1016\/j.injury.2023.05.034"},{"key":"2025081711022871000_9.1.e001521.7","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s40140-020-00374-w","article-title":"Chest Trauma: Current Recommendations for Rib Fractures, Pneumothorax, and Other Injuries","volume":"10","author":"Kim","year":"2020","journal-title":"Curr Anesthesiol Rep"},{"key":"2025081711022871000_9.1.e001521.8","doi-asserted-by":"crossref","first-page":"455","DOI":"10.4097\/kja.19395","article-title":"Ultrasound-guided percutaneous intercostal nerve cryoneurolysis for analgesia following traumatic rib fracture -a case series","volume":"73","author":"Finneran Iv","year":"2020","journal-title":"Korean J Anesthesiol"},{"key":"2025081711022871000_9.1.e001521.9","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1213\/ANE.0000000000001581","article-title":"Continuous Peripheral Nerve Blocks: An Update of the Published Evidence and Comparison With Novel, Alternative Analgesic Modalities","volume":"124","author":"Ilfeld","year":"2017","journal-title":"Anesth Analg"},{"key":"2025081711022871000_9.1.e001521.10","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1016\/j.injury.2021.02.009","article-title":"Surgical stabilization of rib fractures combined with intercostal nerve cryoablation proves to be more cost effective by reducing hospital length of stay and narcotics","volume":"52","author":"Bauman","year":"2021","journal-title":"Injury"},{"key":"2025081711022871000_9.1.e001521.11","doi-asserted-by":"crossref","DOI":"10.1136\/tsaco-2021-000690","article-title":"Efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain after surgery or trauma: systematic review","volume":"6","author":"Cha","year":"2021","journal-title":"Trauma Surg Acute Care Open"},{"key":"2025081711022871000_9.1.e001521.12","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1111\/papr.13182","article-title":"The applications of cryoneurolysis for acute and chronic pain management","volume":"23","author":"Biel","year":"2023","journal-title":"Pain Pract"},{"key":"2025081711022871000_9.1.e001521.13","first-page":"129","article-title":"Pain assessment: global use of the Brief Pain Inventory","volume":"23","author":"Cleeland","year":"1994","journal-title":"Ann Acad Med Singap"},{"key":"2025081711022871000_9.1.e001521.14","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/j.jss.2019.09.032","article-title":"Quantifying Pain Associated With Rib Fractures","volume":"246","author":"Farley","year":"2020","journal-title":"J Surg Res"},{"key":"2025081711022871000_9.1.e001521.15","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(87)91074-8"},{"key":"2025081711022871000_9.1.e001521.16","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0270095","article-title":"Pittsburgh Sleep Quality Index (PSQI) responses are modulated by total sleep time and wake after sleep onset in healthy older adults","volume":"17","author":"Zitser","year":"2022","journal-title":"PLoS One"},{"key":"2025081711022871000_9.1.e001521.17","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/14.5.353"},{"key":"2025081711022871000_9.1.e001521.18","unstructured":"The careguidelines: consensus-based clinical case reporting guideline development. 2023. Available: https:\/\/www.equator-network.org\/reporting-guidelines\/care\/ [Accessed 11 Mar 2024]."},{"key":"2025081711022871000_9.1.e001521.19","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1007\/s11916-023-01172-9","article-title":"Analgesic Techniques for Rib Fractures-A Comprehensive Review Article","volume":"27","author":"Koushik","year":"2023","journal-title":"Curr Pain Headache Rep"},{"key":"2025081711022871000_9.1.e001521.20","doi-asserted-by":"publisher","DOI":"10.1111\/bph.15580"},{"key":"2025081711022871000_9.1.e001521.21","doi-asserted-by":"crossref","first-page":"2597","DOI":"10.1016\/j.neubiorev.2013.08.006","article-title":"The downward spiral of chronic pain, prescription opioid misuse, and addiction: cognitive, affective, and neuropsychopharmacologic pathways","volume":"37","author":"Garland","year":"2013","journal-title":"Neurosci Biobehav Rev"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2024-001521","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T18:03:11Z","timestamp":1755453791000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2024-001521"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,8,22]]},"published-print":{"date-parts":[[2024,8]]}},"alternative-id":["10.1136\/tsaco-2024-001521"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2024-001521","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8]]}}}