Objective: Video-assisted thoracoscopic surgery (VATS) is associated with significant postoperative pain. Multimodal analgesia, including single-shot paravertebral blocks (SPVBs), is widely used but provides limited analgesic duration. Intercostal cryoanalgesia, which offers prolonged pain relief, presents a promising adjunctive option. This study aimed to assess the analgesic benefit of intercostal cryoanalgesia in VATS lung cancer surgery. The primary outcome was thoracic pain during cough 24 hours post-surgery, measured via a Verbal Numerical Rating Scale (VNRS).

Methods: In a randomized, double-blind, controlled trial, 80 patients undergoing VATS lobectomy for lung cancer were assigned to either a Control group receiving standard multimodal analgesia with SPVB or a Cryoanalgesia group receiving additional transpleural intercostal cryoanalgesia (Cryoprobe, Erbe). Thoracic pain at rest and during cough was evaluated at multiple time points up to 6 months postoperatively. Secondary outcomes included quality of recovery (QoR-15), oral morphine equivalents consumption, side effects, thoracic sensory loss (Von Frey filament), and neuropathic pain (DN4 score).

Results: Thoracic VNRS during cough at 24 hours showed no significant difference between groups (4.7 (2.7) vs. 4.8 (2.9); P = 0.78). Pain scores, QoR-15, opioid consumption, side effects, DN4 scores, and sensory loss incidence were comparable over 7 days. Pain scores during cough were significantly higher 1 month after surgery (4.7 (2.4) vs 3.4 (2.0); P = 0.036) but not at 3 month and 6 month follow up.

Conclusions: In this double-blind trial, measurable cryoanalgesia was not observed in the treatment group during cough at 24 hours post-VATS, nor was measurable thoracic sensory loss or improved acute or chronic recovery outcomes.