Background: Rib fractures are common and multimodal pain control bundles are essential to optimal care. Minimizing therapeutic side effects is important among older adults. The purpose of this study is to determine whether addition of CT-guided percutaneous cryoneurolysis (CT-PCN) to existing multimodal pain control bundles reduces pain associated with rib fractures in older adults. Study Design: A prospective, randomized clinical trial assessed addition of CT-PCN to a multimodal rib fracture pain control bundle (Standard of Care SoC) for injured adults ≥65 years. Bluntly-injured patients with fractured ribs 3-9 were randomized ≤72 hours from admission to CT-PCN and SoC, or SoC alone. Primary outcome was highest pain score within 24 hours of discharge with deep inspiration. Secondary outcomes included hospital length of stay, rib-specific readmissions, intervention-associated adverse events, morphine milligram equivalent (MME) use, short-form (SF)-12, and McGill pain scores, assessed at discharge and 1-, 3-, and 12-month intervals post-discharge. Results: 110 patients were included (56 intervention, 54 SoC). No difference in highest pain score with deep inspiration (intervention mean 5.6(SD 2.4) vs SoC mean 5.9(SD 2.4); P=0.49) was within 24 hours of discharge between groups and there was no difference in MME use on day-of-discharge (intervention median 24(IQR 6-45) vs SoC median 15(IQR 4-34); P=0.29). Among 77 participants completing 1-month follow-up (39 intervention, 38 SoC), mean numeric pain score was 1 point worse among intervention patients (intervention mean 2.7(SD 2.4) vs SoC mean 1.7(SD 1.8); P=0.04) and mean sensory pain score was 3.1 points higher (95% CI1.4- 4.9; P<0.001). Conclusions: CT-PCN did not decrease pain associated with rib fractures and may be associated with worse physical quality and emotional response to pain within one month after hospital discharge.
Forrester et al. (Tue,) studied this question.