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

Benjamin A. Keller, Sandra K. Kabagambe, James C. Becker, Y. Julia Chen, Laura F. Goodman, Julianna Myriad Clark-Wronski, Kenneth T Furukawa, Rebecca Stark, Amy Rahm, Shinjiro Hirose, Gary W Raff

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

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. Level of evidence Retrospective study – level III.

Original languageEnglish (US)
Pages (from-to)2033-2038
Number of pages6
JournalJournal of Pediatric Surgery
Volume51
Issue number12
DOIs
StatePublished - Dec 1 2016

Keywords

  • Cryoablation
  • Epidural analgesia
  • Nuss procedure
  • Pain management
  • Pectus excavatum

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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