Cryoneurolysis for Patients Undergoing Surgical Stabilization of Rib Fractures

Key Messages

What Is the Issue?

• Rib fractures pose a substantial clinical burden in patients with blunt trauma and result in significant pain and morbidity. Pain from rib fractures is often intense and prolonged, frequently lasting for several weeks following the injury. The adoption of surgical stabilization of rib fractures (SSRF) has emerged as a key therapeutic option for patients with severe rib fractures.
• Cryoneurolysis is a technology that delivers prolonged analgesia by applying a cryoablation probe at temperatures ranging from −40°C to −70°C for approximately 2 minutes to the intercostal nerves corresponding to the fractured rib levels. Cryoneurolysis has been used as an adjunct to SSRF to improve pain management and other outcomes after surgery.
• A comprehensive assessment of the comparative clinical effectiveness and cost-effectiveness of cryoneurolysis as an adjunct to SSRF through a rapid review is essential to examine potential benefits and harms compared with the existing pain management strategies.

What Did We Do?

• To inform decisions regarding the use of cryoneurolysis for pain management for people undergoing SSRF, we conducted a rapid review to summarize evidence that compared the clinical effectiveness and cost-effectiveness of cryoneurolysis to alternative pain management interventions not involving cryoneurolysis for people undergoing SSRF.
• We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since 2020.

What Did We Find?

• We identified 6 retrospective cohort studies addressing the clinical effectiveness of cryoneurolysis in people undergoing SSRF:
  • Cryoneurolysis used as an adjunct to SSRF was associated with statistically significantly lower or similar postsurgery patient-reported pain intensity, opioid consumption, resource use, in-hospital complications, and adverse events compared to SSRF without cryoneurolysis or with alternative pain management strategies.
  • The statistically significant differences between cryoneurolysis and noncryoneurolysis groups were more evident in reduced postsurgery opioid consumption, and intensive care unit (ICU) and postoperative length of stay (LOS).
  • The certainty of evidence was limited, as all studies had a nonrandomized retrospective design.
• We did not find any studies on the relative cost-effectiveness of cryoneurolysis in people undergoing SSRF.

What Does This Mean?

• Cryoneurolysis may improve clinical outcomes in people undergoing SSRF by reducing postsurgery opioid consumption and resource use without increasing hospital complications and adverse events.
• Widespread implementation should be balanced against current evidence limitations, resource implications, and equity considerations.
• Because cryoneurolysis is typically available in specialized centres with established SSRF expertise, there is a risk of uneven access across regions and populations. Mechanisms such as referral pathways, training, or regional planning may be needed to support equitable access.