{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T15:32:05Z","timestamp":1787585525424,"version":"build-2736575974"},"reference-count":27,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Med. Sci.","Medical Sciences"],"abstract":"<jats:p>Background: Effective opioid-sparing analgesia after median sternotomy remains an unmet need in cardiac surgery. We evaluated whether bilateral intercostal cryoanalgesia, added to standard multimodal analgesia, was associated with postoperative pain, opioid consumption, recovery and early hospital-resource use after isolated coronary artery bypass grafting (CABG). Methods: This single-centre, non-randomised comparative service evaluation included 60 patients undergoing isolated CABG through median sternotomy between 1 November 2025 and 30 May 2026 (30 cryoanalgesia; 30 standard care). The prespecified primary endpoint was cumulative movement-evoked pain burden, quantified as the area under the curve (AUC) for scores recorded on postoperative days 1\u20133. Secondary endpoints included rest-pain AUC, opioid consumption expressed as oral morphine equivalents (OME), time to first bowel opening, postoperative length of stay and an exploratory break-even calculation. Results: Cryoanalgesia was associated with lower movement-pain AUC (adjusted mean difference \u22123.56 score-days, 95% confidence interval [CI] \u22124.62 to \u22122.50; p &lt; 0.001) and rest-pain AUC (\u22123.16 score-days, 95% CI \u22124.19 to \u22122.14; p &lt; 0.001). Total observed opioid consumption was lower by 112.9 mg OME (95% CI \u2212192.8 to \u221233.1; p = 0.006), length of stay by 1.32 days (95% CI \u22121.93 to \u22120.71; p &lt; 0.001), and time to first bowel opening by 0.49 days (95% CI \u22120.92 to \u22120.06; p = 0.027). Conclusions: In this small non-randomised evaluation, bilateral intercostal cryoanalgesia was associated with lower early pain and opioid exposure and faster recovery. Selection, temporal and residual confounding preclude causal or cost-effectiveness conclusions. Prospective randomised evaluation with fixed observation periods and longer-term safety follow-up is required.<\/jats:p>","DOI":"10.3390\/medsci14050510","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T14:49:34Z","timestamp":1787582974000},"page":"510","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bilateral Intercostal Cryoanalgesia After Sternotomy for Coronary Artery Bypass Grafting"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1325-0490","authenticated-orcid":false,"given":"Shahzad G.","family":"Raja","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Harefield Hospital, Hill End Road, London UB9 6JH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amina","family":"Khalil","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Harefield Hospital, Hill End Road, London UB9 6JH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jezerene","family":"Ronquillo","sequence":"additional","affiliation":[{"name":"Department of Pain Management, Harefield Hospital, Hill End Road, London UB9 6JH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Alberici","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Critical Care, Harefield Hospital, Hill End Road, London UB9 6JH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Sear","sequence":"additional","affiliation":[{"name":"Department of Pain Management, Harefield Hospital, Hill End Road, London UB9 6JH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarina","family":"Lenartova","sequence":"additional","affiliation":[{"name":"Department of Pain Management, Harefield Hospital, Hill End Road, London UB9 6JH, UK"},{"name":"Department of Anaesthesia and Critical Care, Harefield Hospital, Hill End Road, London UB9 6JH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nandor","family":"Marczin","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Critical Care, Harefield Hospital, Hill End Road, London UB9 6JH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"ref_1","unstructured":"Writing Committee Members, Lawton, J.S., Tamis-Holland, J.E., Bangalore, S., Bates, E.R., Beckie, T.M., Bischoff, J.M., Bittl, J.A., Cohen, M.G., and DiMaio, J.M. (2022). 2021 ACC\/AHA\/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. J. Am. Coll. Cardiol., 79, e21\u2013e129."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/eurheartj\/ehy394","article-title":"2018 ESC\/EACTS Guidelines on myocardial revascularization","volume":"40","author":"Neumann","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1097\/EJA.0000000000001881","article-title":"Pain management after cardiac surgery via median sternotomy: A systematic review with procedure-specific postoperative pain management (PROSPECT) recommendations","volume":"40","author":"Korir","year":"2023","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1599","DOI":"10.2147\/JPR.S162067","article-title":"Assessment and pathophysiology of pain in cardiac surgery","volume":"11","author":"Zubrzycki","year":"2018","journal-title":"J. Pain Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1097\/AAP.0000000000000663","article-title":"Chronic Poststernotomy Pain: Incidence, Risk Factors, Treatment, Prevention, and the Anesthesiologist\u2019s Role","volume":"42","author":"Kleiman","year":"2017","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"349","DOI":"10.3390\/hearts5030025","article-title":"Multimodal Analgesia Strategies for Cardiac Surgery: A Literature Review","volume":"5","author":"Fernandes","year":"2024","journal-title":"Hearts"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.bpa.2017.07.002","article-title":"Opioid-related side effects: Postoperative ileus, urinary retention, nausea and vomiting, and shivering. A review of the literature","volume":"31","author":"Detriche","year":"2017","journal-title":"Best. Pract. Res. Clin. Anaesthesiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1111\/anae.15262","article-title":"An international multidisciplinary consensus statement on the prevention of opioid-related harm in adult surgical patients","volume":"76","author":"Levy","year":"2021","journal-title":"Anaesthesia"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1016\/j.jtcvs.2023.01.020","article-title":"Pain management and opioid stewardship in adult cardiac surgery: Joint consensus report of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society","volume":"166","author":"Grant","year":"2023","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S3773","DOI":"10.21037\/jtd.2018.09.112","article-title":"Pain management within an enhanced recovery program after thoracic surgery","volume":"10","author":"Thompson","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1016\/j.jtcvs.2019.12.137","article-title":"Significant reduction of postoperative pain and opioid analgesics requirement with an Enhanced Recovery After Thoracic Surgery protocol","volume":"161","author":"Razi","year":"2021","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_12","first-page":"CD009121","article-title":"Paravertebral block versus thoracic epidural for patients undergoing thoracotomy","volume":"2","author":"Yeung","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2404","DOI":"10.1097\/JS9.0000000000000167","article-title":"Relative efficacy and safety of several regional analgesic techniques following thoracic surgery: A network meta-analysis of randomized controlled trials","volume":"109","author":"Li","year":"2023","journal-title":"Int. J. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Mitchell, J., Couvreur, C., and Forget, P. (2024). Recent Advances in Perioperative Analgesia in Thoracic Surgery: A Narrative Review. J. Clin. Med., 14.","DOI":"10.3390\/jcm14010038"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1177\/15569845261436009","article-title":"Cryoanalgesia in Thoracic Surgery","volume":"21","author":"Drake","year":"2026","journal-title":"Innovations"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.bjan.2014.09.003","article-title":"Pain after sternotomy\u2014Review","volume":"66","author":"Huang","year":"2016","journal-title":"Braz. J. Anesthesiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.1053\/j.jvca.2020.09.103","article-title":"Reducing Opioid Use in Patients Undergoing Cardiac Surgery\u2014Preoperative, Intraoperative, and Critical Care Strategies","volume":"35","author":"Ochroch","year":"2021","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1111\/j.1365-2044.1981.tb08673.x","article-title":"Cryoanalgesia. The application of low temperatures to nerves to produce anaesthesia or analgesia","volume":"36","author":"Evans","year":"1981","journal-title":"Anaesthesia"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1016\/j.jtcvs.2025.05.022","article-title":"Intercostal cryoanalgesia for acute pain after video-assisted thoracic surgery lung resection: A randomized controlled preliminary trial","volume":"170","author":"Koliakos","year":"2025","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1097\/EJA.0000000000001600","article-title":"Regional anaesthesia in patients on antithrombotic drugs: Joint ESAIC\/ESRA guidelines","volume":"39","author":"Kietaibl","year":"2022","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1111\/j.1533-2500.2009.00293.x","article-title":"Pain responder analysis: Use of area under the curve to enhance interpretation of clinical trial results","volume":"9","author":"Cappelleri","year":"2009","journal-title":"Pain Pract."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e863","DOI":"10.1097\/PR9.0000000000000863","article-title":"Essential statistical principles of clinical trials of pain treatments","volume":"6","author":"Dworkin","year":"2020","journal-title":"Pain Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1016\/j.jtcvs.2009.03.066","article-title":"Skeletonized internal thoracic artery harvesting reduces chest wall dysesthesia after coronary bypass surgery","volume":"139","author":"Markman","year":"2010","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1213\/00000539-199377020-00026","article-title":"Preemptive analgesia--treating postoperative pain by preventing the establishment of central sensitization","volume":"77","author":"Woolf","year":"1993","journal-title":"Anesth. Analg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1001\/jamasurg.2019.1153","article-title":"Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery After Surgery Society Recommendations","volume":"154","author":"Engelman","year":"2019","journal-title":"JAMA Surg."},{"key":"ref_27","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."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/5\/510\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T15:07:02Z","timestamp":1787584022000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/5\/510"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":27,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["medsci14050510"],"URL":"https:\/\/doi.org\/10.3390\/medsci14050510","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]}}}