NEXT DAY DISCHARGE AFTER THE NUSS PROCEDURE USING INTERCOSTAL NERVE CRYOABLATION, INTERCOSTAL NERVE BLOCKS, AND A PERIOPERATIVE ERAS PAIN PROTOCOL
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In brief
In brief
Prospective study of 40 patients demonstrates that combining intercostal nerve cryoablation with regional blocks and an ERAS pain protocol enables next-day discharge after Nuss procedure in 92.5% of cases. The multimodal approach reduced opioid consumption by 73% while maintaining excellent pain control (median 2/10), eliminating the need for IV narcotics.
Written by the GCMD Library team from the article.
Background
The Nuss procedure for pectus excavatum has historically been associated with significant postoperative pain, which has been the major factor contributing to hospital length of stay (LOS).
Methods
A single-institution, prospective study of 40 consecutive patients undergoing Nuss bar placement for pectus excavatum between November 2019 and January 2021 was conducted to assess the effectiveness of a multimodality pain management protocol. All patients received T3-T8 intercostal nerve cryoablation (INC), T3-T8 bupivacaine intercostal nerve blocks, Exparel at the skin incisions, and management with a perioperative analgesia regimen that minimized narcotic usage. The primary outcome was LOS. Secondary outcomes included opioid use, pain scores, and time to sensory recovery.
Results
37/40 patients (92.5%) were discharged home on postoperative day (POD) 1, and 3/40 (7.5%) were discharged on POD 2 (mean LOS = 1.1 days). The median average postoperative pain score was 2/10. After eliminating IVPCA from our protocol, total oral morphine equivalent (OME) decreased by 73% (55.5 mg to 15 mg) with no change in pain scores or discharge timing.
Conclusions
INC combined with bupivacaine intercostal nerve blocks and a pre- and post-hospital analgesia protocol facilitated discharge one day after the Nuss procedure, achieved excellent pain control, and eliminated the need for intravenous opioids.