Introduction:
The gold standard for the surgical treatment of pleural effusion is pleural drainage using video-assisted thoracoscopy (VATS). Intraoperative intercostal nerve cryoanalgesia may be a solution to reduce both the supply of analgesics, including opioids, and hospitalisation time.

Aim:
The aim of the study was to describe the use of cryoanalgesia for better pain control during pleural drainage in the course of pneumonia complicated by pleural effusion.

Case study:
A 6-year-old male patient was admitted to the Department of Paediatric Surgery for treatment of pleural empyema in the course of pneumonia. After no regression of the pleural lesions, the patient was qualified for surgical treatment. Pleural drainage uduring VATS and intraoperative intercostal nerve cryoanalgesia was performed. The mean numerous rating scale of pain (NRS) score during the first 5 days after drain insertion was 4, 4, 3, 3, 2 points. The only pharmacological drug used in postoperative pain treatment was paracetamol and, on day 1, Nalbuphine. The patient was discharged from hospital after 1 week. No complications after the procedure were noted.

Results and discussion:
The standard treatment for pneumonia complicated by effusion is a prolonged course of intravenous antibiotic therapy as a first-line treatment, but most patients can be treated with pleural drainage using VATS to remove the fibrin surrounding the lung. Intraoperative intercostal nerve cryoanalgesia can support analgesic treatment during pleural drainage and also reduces the number of adverse reactions occurring when opioids are used.

Conclusions:
Intraoperative intercostal nerve cryoanalgesia is a safe method for patients requiring pleural drainage during the VATS procedure. Performing VATS-guided pleural drainage is a safe and effective method for treating pleural empyema.