Baylor doctors find method to prescribe less opioids after lung transplant surgery

At Baylor College of Medicine, physicians are constantly seeking better ways to support patient recovery. A recent study led by Dr. Ramiro Fernandez and Dr. Gabriel Loor highlights a promising technique to manage pain following lung transplantation: intercostal nerve cryoablation (INC). The approach not only reduced opioid use but also helped patients breathe better and recover more fully after surgery.

Why pain control matters

Lung transplants are major surgeries. They involve incisions long enough to allow surgeons to see inside the chest, which can leave physicians struggling to reduce pain post-surgery. If that pain isn’t well managed, it can be difficult for patients to take deep breaths, cough or be mobile — all key components to a smooth recovery.

Traditionally, this pain has been managed with opioid medications, which, while effective, come with a host of potential side effects: suppressed breathing, confusion, constipation and the risk of long-term dependence. For lung transplant patients, who are especially vulnerable, minimizing opioid exposure is critical for both lung function and overall recovery.

“Uncontrolled pain can delay healing and increase the risk of complications like pneumonia,” said Fernandez, assistant professor in the David J. Sugarbaker Division of Thoracic Surgery at Baylor. “But too much opioid use carries its own risks, especially for this population.”

Freezing nerves to ease pain

The Baylor team looked at a technique called intercostal nerve cryoablation (INC). It involves freezing the nerves between the ribs during surgery to block pain signals before they start. The idea is to prevent pain, rather than just treat it afterward.

In their study, researchers compared two groups of lung transplant patients: one received standard postoperative pain management, while the other underwent INC during surgery. The findings were significant. Patients who received INC used more than 40% fewer opioids two weeks postoperatively.

Less pain, better breathing

Even better, the patients who received INC had stronger lung function six and 12 months after surgery.

“Good pain control isn’t just about comfort,” Fernandez said. “It helps patients breathe better, get moving sooner and recover more smoothly.”

The study also concluded INC was safe. There were no more complications in the INC group than in the other group, and survival rates were the same after a year. Loor, who led the team, sees this as a big win for transplant patients.

“This technique gives us a reliable low-risk way to reduce opioid use and help our patients recover more fully,” said Loor, associate professor in the Division of Cardiothoracic Transplantation and Circulatory Support at Baylor and surgical director of Lung Transplant Program at Baylor St. Luke’s Medical Center.

The lung transplant team is currently enrolling patients in the REDUCE Registry, a multicenter, industry-sponsored study designed to provide deeper insight into the effects of cryoablation. With promising results like these, more centers may start using INC as part of a modern approach to pain management after lung surgery.

By the Michael E. DeBakey Department of Surgery