Abstract
Background
Management of pain from traumatic rib injury is very challenging. Both acute and chronic
pain caused by rib injury can cause significant morbidity (pain-induced hypoventilation,
pneumonia, respiratory failure) and functional hindrance. Traditional pain management
strategies in the emergency department (ED) that target acute traumatic rib pain are
limited by the side effects of medications or the temporary half-life of anesthetics
used for a nerve block. Both treatment modalities fall short of addressing subsequent
chronic sequelae.
Case Report
We present the first-time use of cryoneurolysis on an ED patient for the treatment
of 10/10 severe traumatic intercostal neuralgia that resulted in the patient being
discharged home pain free. The patient initially underwent a multilevel left-sided
T5–T7 intercostal nerve block, followed by ultrasound-guided percutaneous cryoneurolysis
of those intercostal nerves using two cycles of 2 min of cooling to a temperature
of −70°C (nitrous oxide), with 30 s of thawing in between. The patient experienced
100% pain relief immediately post procedure that was sustained. He remained completely
symptom free more than 6 months after the bedside procedure and returned to sports
without restrictions.
Why Should an Emergency Physician Be Aware of This? This case highlights the benefits of cross-departmental collaboration between the
ED, Anesthesia, and Pain Management. We hope this model of multidisciplinary pain
modulation can be replicated for other patients with similar pain and can herald a
new paradigm of pain management in the ED.
Keywords
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Article info
Publication history
Published online: June 08, 2022
Accepted:
June 4,
2022
Received in revised form:
May 8,
2022
Received:
January 11,
2022
Identification
Copyright
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