Intercostal nerve cryoablation versus thoracic epidural catheters for postoperative analgesia following pectus excavatum repair: Preliminary outcomes in twenty-six cryoablation patients

Infographic · Oct 2018 · 1 min read

In brief

Retrospective comparison of 52 pediatric pectus excavatum patients shows intercostal nerve cryoablation significantly reduces hospital stay, telemetry monitoring time, and IV narcotic use compared to thoracic epidural analgesia. Cryoablation demonstrates promise as an alternative pain management strategy for Nuss procedure patients despite slightly higher complication rates.

Intercostal nerve cryoablation significantly reduces hospital length of stay compared to thoracic epidural analgesia after Nuss procedure
Cryoablation decreases total IV narcotic use and duration of IV narcotic administration in pediatric pectus excavatum repair patients
Cryoablation reduces telemetry monitoring time, allowing faster transition from intensive monitoring to standard care
Despite slightly higher complication rates, cryoablation has replaced epidurals as preferred pain management at these institutions
Multimodal pain strategies for pectus repair remain evolving; cryoablation shows promise as epidural alternative in children

Written by the GCMD Library team from the infographic.

Two-panel infographic with teal background. Left panel shows anatomical illustration of ribcage with nerve pathway highlighted. Right panel displays two icons: medication pills and hospital building, each paired with outcome metrics. Journal branding appears at bottom.

Background

Multimodal pain management strategies are used for analgesia following pectus excavatum repair. However, the optimal regimen has not been identified. We describe our early experience with intercostal cryoablation for pain management in children undergoing the Nuss procedure and compare early cryoablation outcomes to our prior outcomes using thoracic epidural analgesia.

Methods

A multi-institutional, retrospective review of fifty-two patients undergoing Nuss bar placement with either intercostal cryoablation (n = 26) or thoracic epidural analgesia (n = 26) from March 2013 to January 2016 was conducted. The primary outcome was hospital length of stay. Secondary outcomes included telemetry unit monitoring time, total intravenous narcotic use, duration of intravenous narcotic use, and postoperative complications.

Results

Patients who underwent intercostal cryoablation had a significant reduction in the mean hospital length of stay, time in a monitored telemetry bed, total use of intravenous narcotics, and the duration of intravenous narcotic administration when compared to thoracic epidural patients. Cryoablation patients had a slightly higher rate of postoperative complications.

Conclusion

Intercostal cryoablation is a promising technique for postoperative pain management in children undergoing repair of pectus excavatum. This therapy results in reduced time to hospital discharge, decreased intravenous narcotic utilization, and has eliminated epidurals from our practice.

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