IPEG 2018 - OUTCOMES USING CRYOABLATION FOR POST-OPERATIVE PAIN CONTROL IN CHILDREN
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Pectus excavatum repair is the most common chest wall deformity in children.
Pain after pectus excavatum repair is the main factor determining post-operative course.
Traditional pain control methods for pectus excavatum repair include epidural catheters and patient-controlled analgesia.
The study was a single center retrospective review between January 1st and August 21st of 2017 of all children undergoing minimally invasive pectus excavatum repair.
The minimally invasive pectus excavatum repair utilizes bilateral axillary incisions and a subxiphoid incision, via which blunt dissection is performed to connect these sides.
A 5 millimeter port is placed at the posterior aspect of the axillary incision to introduce the camera for thoracoscopic visualization.
All cryoablation is performed thoracoscopically under direct visualization.
The cryoablation probe is placed on the superior aspect of the fourth intercostal space, and a freeze is activated which lasts 120 seconds followed by a brief thaw cycle.
Cryoablation is performed through T4 and T7 bilaterally.
Once the thaw cycle is complete, the probe detaches from the tissue and is no longer cool enough to damage surrounding tissue.
The study included 19 patients who did not undergo cryoablation and 9 who did.
There was no difference in gender or BMI between the cryoablation and non-cryoablation groups.
Patients who underwent cryoablation had a higher Haller corrective index in comparison to those who did not.
The operative time in the cryoablation group was approximately 30 minutes longer than the non-cryoablation group due to the 120-second cycles required to perform cryoablation.
Time to oral pain control was 1.2 days in the cryoablation group compared to 2.6 days in the non-cryoablation group.
Patients who underwent cryoablation stayed in the hospital for 1.4 days compared to 4 days for their counterparts.
6 out of 9 patients (67%) in the cryoablation group were discharged home on post-operative day one.
Time to discontinuation of oral narcotics was 8.2 days in the cryoablation group compared to 18.2 days in the non-cryoablation group.
There were no complications from bar placements in the non-cryoablation group.
One cryoablation patient returned with a pneumothorax, which was managed without any chest tube.
Patients who underwent cryoablation had lower pain scores on post-operative day 0 and 2, and similar scores on post-operative day 1.
No patients in the cryoablation group stayed after post-operative day 2.
With familiarity with the cryoablation procedure, operative time has decreased to approximately 20 minutes at their institution.
Cryoablation has become the preferred method of pain control at their institution.
The institution has begun a prospective observational trial to verify the cryoablation findings.