Cryoanalgesia in Lung Transplantation - A Systematic Review and Meta-analysis.

Background: Lung transplantation is a crucial treatment for end-stage lung diseases. However, postoperative pain management remains a significant challenge. Therefore, this study aims to examine the implications of adoption cryoanalgesia on lung transplantation pain control protocol. Methods: Three databases were searched for studies comparing cryoanalgesia versus standard of care analgesia in patients after lung transplantation. The primary outcome was opioid consumption throughout the entire hospitalization, at postoperative day (POD) 7 and at POD 14 addressed with Morphine Milligram Equivalents (MME). The secondary outcomes were maximum reported pain score at POD 7, hospital length of stay (LOS) and time until extubation. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated for continuous outcomes. Results: A total of 5 studies encompassing 485 patients undergoing lung transplantation were included, of whom 228 underwent cryoanalgesia. Compared to standard of care, cryoanalgesia demonstrated significant reduction in opioid consumption at POD 7 (MD: -96.79 MME, 95% CI -183.40 to -10.18, p=0.03), at POD 14 (MD -225,26 MME; 95% CI -366.58 to -83.94; p<0.01) and throughout the entire hospitalization (MD: -307.76 MME, 95% CI -461.72 to -153.79, p<0.01). In addition, there was a significant reduction in pain scores in the cryoanalgesia group (MD: -1.10 points, 95% CI -1.77 to -0.43, p<0.01). However, no significant differences were found regarding hospital LOS or time until extubation. Conclusions: This meta-analysis indicates that cryoanalgesia effectively reduces opioid requirements and pain levels in lung transplant patients.