Early Outcomes from the Use of Thoracic Epidural Analgesia versus INC Cryoablation during Lung Transplantation - A Single Center Experience

Document Type

Conference Proceeding

Publication Date

2025

Publication Title

Journal of Heart and Lung Transplantation

Abstract

Purpose: Thoracic epidural analgesia (TEA) is the standard approach for post-operative pain control following lung transplantation (LTX), but has the potential to induce hypotension and other adverse effects. The use of intercostal nerve cryoablation (INC) may offer advantages over TEA and we recently introduced this approach in our program. We sought to compare early post-operative outcomes before and after this change. Methods: Adult LTX recipients who underwent transplant surgery between Feb. 2013 and June 2024 were included. INC was employed starting Sept. 2022. Wilcoxon rank-sum tests were used to compare lengths of stays (LOS), duration of post-op vasopressor requirement, and duration of mechanical ventilation between TEA and Cryo. Postoperative ileus and acute kidney injury (AKI) were assessed using Chi-square analysis and AKI stages with Fisher’s Exact test, respectively. Pain scores were graded on a scale of 0-10 and the mean score during the first 14 days post-transplant were evaluated with T-tests. Results: The TEA group (N=292) had similar demographics to the INC group (N=81). The INC group included a higher proportion of recipients with underlying restrictive lung disease (72% vs. 60%) and bilateral lung transplants (90% vs. 73%). No significant differences were observed in ICU or total hospital LOS, duration of mechanical ventilation or duration of post-op vasopressor requirements. While the incidence of any AKI was similar (41% in INC vs. 40% in TEA), there was a strong trend for less stage 3 AKI in the ICN group (6% vs. 19%; P=0.09). INC recipients had a higher mean average pain score compared to the TEA group (4.74 vs 4.09; P=0.0005). Fewer patients experienced post-op ileus in the TEA group (19% vs 30%; P=0.05). Conclusion: Early post-operative outcomes after LTX using INC are comparable to TEA. Pain control, while generally adequate, was less compared with TEA and this may explain the higher incidence of ileus. An important reduction in severe AKI was observed with INC, suggesting less postoperative hypotension. Additional studies are required to determine the optimal strategy for post-operative analgesia after LTX.

Volume

44

Issue

4 Suppl

First Page

S217

Comments

45th Annual Meeting & Scientific Sessions of the International Society for Heart and Lung Transplantation (ISHLT) Apr 27-30, 2025 Boston, MA

Last Page

S217

DOI

10.1016/j.healun.2025.02.440

ISSN

1053-2498

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