Outcomes Using Cryoablation for Postoperative Pain Control in Children Following Minimally Invasive Pectus Excavatum Repair.
PURPOSE: Pain is the main factor that determines the postoperative course for patients undergoing pectus bar placement. Cryoablation of the intercostal nerves has been suggested to mitigate this pain. We instituted a protocol for using intercostal cryoablation and report our early results compared to our immediately previous cohort.
MATERIALS AND METHODS: A retrospective study was conducted on patients undergoing minimally invasive repair for pectus excavatum between January 1, 2017, and August 21, 2017. Demographic data, anthropometrics, operative times, type and duration of patient analgesia, and postoperative length of stay were collected. Descriptive statistics were performed with all means reported ± standard deviations. Comparisons between groups were analyzed on STATA using T-tests with a P value
RESULTS: Twenty-eight patients were treated for pectus excavatum during the study period with 9 (32%) undergoing cryoablation. Mean number of rib spaces ablated was 5 ± 0.53 with no reported intraoperative complications. Mean operative time was 30 minutes longer in the cryoablation group (P = .00). Days to only oral pain medication was shorter in the cryoablation group, (1.22 ± 0.66 day versus 2.63 ± 0.68 day, P = .00). Length of stay, in days, was shorter in the cryoablation group (1.4 ± 0.72 days versus 4.0 ± 1.0 days, P = .00). There were no reported complications from cryoablation or bar placement during the study period. Days to discontinuation of oral narcotics were less in the cryoablation group (8.2 ± 7.0 versus 18.2 ± 10.4, P = .00).
CONCLUSION: Cryoablation after pectus bar placement dramatically decreases narcotic usage and postoperative length of stay.
Journal of laparoendoscopic & advanced surgical techniques. Part A
Adolescent; Analgesics; Child; Cohort Studies; Cryosurgery; Female; Funnel Chest; Humans; Intercostal Nerves; Length of Stay; Male; Minimally Invasive Surgical Procedures; Narcotics; Operative Time; Pain, Postoperative; Retrospective Studies
cryoablation; epidural; minimally invasive; patient-controlled anesthesia; pectus excavatum
Sujka J, Benedict LA, Fraser JD, Aguayo P, Millspaugh DL, St Peter SD. Outcomes Using Cryoablation for Postoperative Pain Control in Children Following Minimally Invasive Pectus Excavatum Repair. J Laparoendosc Adv Surg Tech A. 2018;28(11):1383-1386. doi:10.1089/lap.2018.0111