Objective:

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Background:

Persistent postoperative pain following thoracic surgery is often attributable to intercostal nerve injury sustained during the procedure. Advancements in minimally invasive surgical techniques such as Video-Assisted Thoracoscopic Surgery (VATS) and Robotic-Assisted Thoracic Surgery (RATS) have resulted in reduced pain post-surgery, however it remains a substantial clinical concern. The analgesic technique of intraoperative intercostal nerve cryoablation, an opioid-sparing approach, has shown promising results in combatting this problem. However, the current practice, characterized by reliance on anatomical landmarks for probe placement and a predetermined ablation duration, may contribute to inadequate cryoablation owing to potential errors in probe location or insufficient ablation time. This case report emphasizes the innovative use of transcranial motor evoked potentials (tcMEPs) with recording at intercostal muscles to ascertain the successful completion of intercostal nerve cryoablation, signaling potential advancements in the postoperative pain management landscape and a new use case for intraoperative neurophysiologic monitoring (IONM) in thoracic surgeries.

Design/Methods:

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Results:

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Conclusions:

This case report presents a new use of transcranial motor evoked potentials (tcMEPs) to monitor the effectiveness of intraoperative intercostal nerve cryoablation in thoracic surgery. Utilizing intraoperative neurophysiologic monitoring (IONM) in this context represents a novel application in thoracic surgeries. This approach could potentially enhance postoperative pain management, which underscores its clinical impact and signifies a promising path for future investigations.