Effectiveness of one minute per level intercostal nerve cryoablation for postoperative analgesia after surgical correction of pectus excavatum

Suhail Zeineddin, Seth D. Goldstein, Samuel Linton, Christopher DeBoer, Amin Alayleh, Irma Ortiz, Laurie Sands, Suzanne Kujawa, Santhanam Suresh, Hassan Ghomrawi, Fizan Abdullah*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Intraoperative intercostal nerve cryoablation has emerged as a promising modality for postoperative analgesia following Surgical Correction of Pectus Excavatum (SCOPE). Most centers use two-minute cryoablation per level, although data from histologic and adult studies suggest the effectiveness of one-minute freezes. We aimed to describe our center's experience with one minute per level cryoablation. Methods: A retrospective single institution review of patients undergoing SCOPE was performed to compare patients pre- and post-intercostal nerve cryoablation implementation. Cryoablation was performed as one minute for each of the thoracic intercostal nerves T3-T7. Multivariable regression analyses were conducted to compare the outcomes and cost between pre- and post-implementation groups. Results: During the study period, 198 patients underwent SCOPE with one Nuss bar, receiving either intraoperative intercostal nerve cryoablation (Cryo, n = 100) or preoperative thoracic paravertebral catheters (NoCryo, n = 98). Surgical time was on average 9 min longer for the Cryo group (p<0.01). Median length of stay for the Cryo group was 3 days shorter compared to the NoCryo group (p<0.01). The Cryo group had a 19-fold and 5.6-fold reduction in average inpatient and total postoperative opioid usage, respectively (p<0.01). Total hospital costs were significantly lower in the Cryo group (p<0.01). Overall complication rate was not statistically significant different between the two groups. Conclusions: Intraoperative one minute per level cryoablation is a potent approach to postoperative analgesia for SCOPE patients that led to a shorter hospital length of stay, lower hospital costs, and decreased opioid use compared to conventional analgesia at our institution. Pediatric surgeons performing correction of chest wall deformities should consider offering this technique.

Original languageEnglish (US)
Pages (from-to)34-40
Number of pages7
JournalJournal of pediatric surgery
Volume58
Issue number1
DOIs
StatePublished - Jan 2023

Keywords

  • Cryoanalgesia
  • Intercostal cryoablation
  • Nuss bar
  • Nuss procedure
  • Pectus excavatum
  • SCOPE
  • Thoracoscopy

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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