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Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)Background and Aims Percutaneous intercostal nerve cryoneurolysis (IC) has potential advantages over established regional-analgesia for the acute treatment of rib fractures. Intercostal nerve cryoneurolysis could provide extended analgesia and negate the need for indwelling regional analgesia catheters. Here we explore ICs potential benefits at a Major Trauma Centre.Methods Patients were offered IC when an erector spinae plane (ESP) catheter was indicated for less than 5 unilateral rib fractures that were anterior or lateral. Patients either received IC first line or second line (day 1 or day 2 after ESP catheter was sited.) The Metrum CRYO-S Painless system with A-13/120/R/RF probes were used to deliver intercostal nerve cryoneurolysis. Pain was assessed immediately following IC, if pain not adequately controlled then an ESP catheter was sited or ESP continued.Results The IC procedure was tolerated under local anaesthesia, no complications reported at time of writing. Five patients received IC. Two patients received IC first line ( table 1 attached). Three patients received IC day one Post-ESP catheter inserted (table 2 attached). Post-cryoanalgesia, two of the patients did not require their ESP for their remaining hospital stay. One patient resumed their ESP infusion after six hours. Abstract P258 Tables 1 and 2Conclusions Intercostal Cryoanalgesia is a well tolerated therapy that is a feesable alternative to ESP catheters in the management of traumatic rib fractures, with the added potential benefit of extended analgesia and reduced length of hospital stay. A more detailed service evaluation with a larger cohort including spirometry is justified at our institution. In conclusion, IC has the potential to be effective analgesia and cost saving via reducing length of hospital stay in the management of acute traumatic rib fractures.