Comparison of Multimodal Pain Control Following Bilateral Lung Transplantation

Purpose: Opioid administration is common following bilateral lung transplantation (BLTx) but is associated with adverse side effects and potential for opioid use disorder. This study aimed to compare the use of intercostal cryoablation, liposomal bupivacaine (LipoB), and standard therapy on patient-reported pain, opioid administration, and clinical outcomes following BLTx. Methods: A retrospective review of all BLTx performed at a single center from January 2016 to December 2023 was performed. Due to varying surgeon preferences, patients received intraoperative cryoablation or LipoB in addition to systemic pain control measures or systemic measures only in the intra- or peri-operative period. Primary outcomes included patient-reported pain and the amount of opioid administration. Secondary outcomes included opioid-related complications and perioperative outcomes. Opioid administration was standardized using morphine milligram equivalents. Opioid levels and pain scores were predicted using a mixed-effects model. Results: Of the 153 patients included, 42.5% (n = 65) received systemic-only, 31.4% (n = 48) received LipoB, and 26.1% (n = 40) received cryoablation. Patients receiving cryoablation reported significantly lower pain through postoperative day 14 (P < .0001). Opioid administration was not different between groups (P = .107). Patients receiving cryoablation had lower rates of postoperative ileus (P = .004) but longer intensive care unit and postoperative length of stay (P < .001). Conclusion: Cryoablation was associated with a clinically significant reduction in patient-reported pain following BLTx. Significantly longer length of stay in the cryoablation group warrants future prospective, randomized investigation.