Effect of cryoablation in Nuss bar placement on opioid utilization and length of stay
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In brief
In brief
This retrospective study compared intercostal nerve cryoablation to paravertebral blocks for pain control after minimally invasive pectus excavatum repair in 255 pediatric patients. Cryoablation reduced inpatient opioid use by half, discharge prescriptions by 75%, and hospital stay by one day, despite adding 25 minutes to operative time.
- Intercostal nerve cryoablation reduced inpatient opioid use by >50% compared to paravertebral blocks after pectus excavatum repair.
- Cryoablation decreased length of stay by 1 day (3 vs 4 days) without increasing complication rates.
- Opioid prescriptions at discharge were 4-fold lower with cryoablation (90 MME vs 390 MME).
- Cryoablation added 25 minutes to operative time but provided superior postoperative pain control.
- Transition from nerve blocks to cryoablation offers a safer opioid-sparing strategy for pediatric thoracic surgery.
Written by the GCMD Library team from the article.
Abstract
Background
Our institution recently transitioned from paravertebral nerve blocks (PVBs) to intercostal nerve cryoablation (INC) for pain control following minimally invasive repair of pectus excavatum (MIRPE). This study aimed to determine how INC affected the operative time, length of stay, complication rates, inpatient opioid use, and outpatient prescription of opioids at a single center.
Methods
A retrospective review was performed at a single pediatric referral center of all patients who underwent MIRPE between 2018 and 2023. Patient demographics, operative details, and perioperative course were collected. The use of INC versus PVB was recorded. Univariate analyses were performed using Wilcoxon rank sum tests for continuous variables and chi-squared tests for categorical variables.
Results
255 patients were included with a median age of 15 years, median BMI of 18.50 kg/m2, and median Haller index of 4.40. INC was utilized in 41% (105/255), and 59% (150/255) received PVB. The two groups did not differ significantly in BMI, Haller index, or complications, though the INC patients were older by 1 year (15.0 vs. 16.0, p = 0.034). INC was associated with an increased operative time (INC: 92 min vs. PVB: 67 min, p < 0.001), decreased length of stay (3 vs. 4 days, p = < 0.001), more than twofold decrease in inpatient opioids per day (INC: 16 MME vs. PVB: 41 MME, p < 0.001), and a fourfold decrease in the amount of opioids prescribed at discharge (INC: 90 MME vs. PVB: 390 MME, p < 0.001).
Conclusion
INC after MIRPE significantly decreased both the inpatient opioid utilization and our outpatient prescribing practices while also decreasing our overall length of stay without increasing complications.
Level of Evidence
Level III.