Ultrasound-guided, percutaneous cryoneurolysis of intercostal nerves in high-risk, traumatic rib fracture patients.

Abstract

Traumatic rib fractures in high-risk patients present significant challenges in pain management, with inadequate analgesia leading to pulmonary complications, prolonged hospitalization, and increased morbidity. Conventional pain management strategies, including opioid-based regimens and catheter-based regional anesthesia, have undesirable side effects and limited duration analgesia. Cryoneurolysis overcomes many of these limitations and provides more sustained analgesia that better aligns with the expected prolonged pain trajectory of traumatic rib fractures. This brief technical report and case series details a description of our ultrasound technique we employ for percutaneous cryoneurolysis of intercostal nerves to achieve potent analgesia for traumatic rib fractures. We describe five cases of severe, high-risk traumatic rib fractures, as defined by a Rib Fracture Score >6 and STUMBL Score ≥26, who received ultrasound-guided, percutaneous cryoneurolysis of intercostal nerves for analgesia. Following cryoneurolysis, all patients showed significant clinical improvements, including better pain scores, reduced opioid consumption, rapid weaning from supplemental oxygen, and accelerated rehabilitation toward hospital discharge. Ultrasound-guided, percutaneous cryoneurolysis represents a promising, minimally invasive technique for managing pain associated with traumatic rib fractures in high-risk patients. The procedure offers sustained analgesia, improved respiratory function, and reduced systemic analgesic requirements while maintaining a favorable risk-benefit profile.