Cost and outcomes of intercostal nerve cryoablation versus thoracic epidural following the Nuss procedure
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- Intercostal nerve cryoablation reduces PCA use and total opioid requirements compared to thoracic epidural after Nuss procedure.
- Cryoablation shortens hospital length of stay versus epidural analgesia in pectus excavatum repair patients.
- Cryoablation increases operative time and total hospitalization cost despite reducing opioid use and LOS.
- Both pain control modalities have distinct trade-offs: cryoablation favors opioid reduction, epidural favors cost efficiency.
- Retrospective data (2002-2020) from Penn State supports individualized pain management strategy selection for Nuss patients.
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Thoracic epidural and intercostal nerve cryoablation are two options for pain control in patients undergoing a Nuss procedure for pectus excavatum. Now, what are the benefits of each? I'm Alex Halpern, a general surgery resident at George Washington University, working with Cincinnati Children's, and this is an article that you should know. Dr. Tsai and his team from Penn State conducted a retrospective chart review, looking at kids who underwent a Nuss procedure between 2002 and 2020 and comparing the outcomes and cost of intercostal nerve cryoablation and epidural. They found that the intercostal nerve cryoablation group had lower rates of PCA use, lower total morphine milligram equivalent requirement, and the shorter length of stay in the hospital. This group also had longer operative times and a higher total hospitalization cost than the thoracic epidural group. So it seems like both of these options have their pros and cons, with the intercostal nerve cryoablation group having a decreased total opioid use and decreased length of stay in the hospital, but increased operating room times and increased total cost. Let us know what you think in the comments below.