Comparison between cryoanalgesia, epidural anaesthesia and erector spinae plane block for postoperative analgesia after minimally-invasive anatomic lung resection: a randomized controlled trial.

Regional anaesthesia technique play a fundamental role in pain control after minimally invasive anatomic lung resection. In this setting, cryoanalgesia has been scarsely investigated. The aim of this study is to compare cryoanalgesia with two among the most effective regional anaesthesia techniques: erector spinae plane block (ESPB), and epidural analgesia (EA). Patients scheduled for minimally invasive anatomic lung resection were randomized to receive either cryoanalgesia, ESPB or EA (25 patients per group). Static and dynamic pain scores were evaluated at multiple time points up to 2 months postoperatively. The primary outcome measure was the static pain score, assessed with the numeric rating scale (NRS) at 24 h from surgery. Secondary outcomes included opioid consumption, patient satisfaction, and use of painkillers at two months. Static NRS pain scores at 24 h showed no significant difference between groups (1.92 (± 2.12), 2.63 (± 2.14), and 2.45 (± 1.95) for cryoanalgesia, ESPB, and EA, respectively, p= 0.494). Among secondary outcomes, EA was associated with lower intraoperative remifentanil doses and a trend towards better patient satisfaction at 2 months than the two other techniques; while pain scores at other time points and postoperative opioid consumption were comparable. No significant differences in postoperative pain control were observed among patients receiving cryoanalgesia, EA, or ESPB during the first 48 postoperative hours or at 2 months after surgery. Further studies are needed in order to understand how to improve the efficacy of cryoanalgesia for minimally-invasive lung resections.