Initial Outcomes Using Cryoablation in Surgical Management of Slipping Rib Syndrome | 2018-2020 | Retrospective chart review | Patients undergoing cartilaginous rib excision (CRE) | 98 patients | 68 CRE without cryo | 22 CRE + Cryo | 8 Combined MIRPE* + CRE + Cryo | 90% patients underwent bioabsorbable rib plating | CRE + Cryo patients (0.6 OME/kg) used significantly less opioids in hospital vs. CRE without cryo (1.0 OME/kg) | The median length of stay (LOS) in CRE + Cryo was 1 day vs. 2 days in CRE without cryo | MIRPE + CRE + Cryo patients used 0.6 OME/kg opioids with a 2 days LOS | *MIRPE: Minimally invasive repair of pectus excavatum | Conclusion: Intercostal nerve cryoablation reduces opioid use and LOS in patients undergoing cartilaginous rib excision for slipping rib syndrome. | https://http://doi.org/10.1016/j.jpedsurg.2022.12.031 | Source: Lai K et al. | Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA | @EmGooteeMD | @StayCurrentMD | Cincinnati Children's | Journal of Pediatric Surgery
Initial Outcomes Using Cryoablation in Surgical Management of Slipping Rib Syndrome
Infographic · Oct 2023 · 1 min read
In brief
In brief
Retrospective study of 98 patients demonstrates that intercostal nerve cryoablation during cartilaginous rib excision for slipping rib syndrome significantly reduces postoperative opioid use and may shorten hospital stay. Extra-thoracic cryoablation of T9-T10 nerves proved safe without causing abdominal wall laxity.
- Intercostal nerve cryoablation significantly reduced in-hospital opioid use (0.6 vs 1.0 OME/kg) in slipping rib syndrome surgery patients.
- Cryoablation trended toward shorter hospital stays (1 vs 2 days median LOS) after cartilaginous rib excision procedures.
- Extra-thoracic cryoablation technique avoids need for thoracoscopy while maintaining pain control benefits in CRE procedures.
- Cryotherapy applied to T9/T10 intercostal nerves showed no abdominal wall laxity at follow-up, supporting safety of lower intercostal ablation.
- 91% of patients received bioabsorbable rib plating, with cryoablation enhancing recovery in this predominantly female adolescent cohort.
Written by the GCMD Library team from the infographic.
A teal and yellow infographic with a calendar icon, anatomical rib illustration, snowflake icons representing cryoablation, pill graphics, and a healthcare provider illustration. Data is presented in colored text blocks with visual hierarchy emphasizing key statistics and the conclusion at bottom.
Krista Lai, R Scott Eldredge, Melissa Nguyen, Benjamin E. Padilla, Lisa E. McMahon
Introduction: Minimally invasive repair of pectus excavatum (MIRPE) and cartilaginous rib excision (CRE) for slipping rib syndrome (SRS) are painful procedures. Intercostal nerve cryoablation (Cryo) controls pain and decreases opioid use in MIRPE. Herein, we describe our experience with cryoablation in CRE.
Methods: A retrospective chart review was performed of all patients undergoing CRE between 2018 and 2022. Data on demographics, clinical characteristics, operative details, and hospital course were collected.
Results: A total of 98 patients underwent CRE: 68 CRE without cryo, 22 CRE + Cryo, and 8 combined MIRPE + CRE + Cryo. Ninety percent of patients underwent bioabsorbable rib plating. Patients were predominantly female (79%, 73%, 50% respectively) with median ages 17.6, 16.9, and 14.2 years respectively. CRE + Cryo patients used significantly less opioids in hospital (0.6 OME/kg [0.1,1.2]) compared to CRE without cryo (1.0 OME/kg [0.6,2.1]), p < 0.05. The median length of stay (LOS) in CRE + Cryo was 1 day [1,2] compared to 2 days in CRE without cryo [1,2], p = 0.09. MIRPE + CRE + Cryo patients used 0.6 OME/kg [0.2,8.0] with a 2 day [1,5.5] LOS. Ninety-one percent of Cryo patients had cryoablation of T9 and/or T10 intercostal nerves, with no documented abdominal wall laxity at median follow-up of 16 days. Cryo was applied extra-thoracically in CRE + cryo without thoracoscopy or lung isolation, while MIRPE + CRE + Cryo used a combination extra-/intra-thoracic cryoablation in with thoracoscopy.
Conclusion: Intercostal nerve cryoablation reduces opioid use and LOS in patients undergoing cartilaginous rib excision for slipping rib syndrome. Cryotherapy to as low as T10 did not result in abdominal wall laxity and can be applied extra-thoracically without the need for thoracoscopy. Ongoing prospective studies are required to assess the long-term outcomes.