Cost and outcomes of intercostal nerve cryoablation versus thoracic epidural following the Nuss procedure

Holguin, Rolfy A. Perez; DeAngelo, Noah; Sinha, Asru K.; Shen, Chan; Tsai, Anthony

doi:10.1016/j.jpedsurg.2022.12.011

Cited by 10 publications

(14 citation statements)

References 20 publications

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“…The LOS was three days shorter in the cryoablation group, which is similar to the literature (LOS varying from -2 to -3 days) [3][4][5]8 .…”

Section: Lossupporting

confidence: 88%

“…Perez Holguin et al used both methods and obtained similar results as ours (discontinuation of PCA after 1 day vs. after 4 days), also showing a difference in percentage of patients requiring narcotics on discharge (100 vs. 54.8%). 5 We achieved even better results at discharge, and further demonstrated that opioid usage after 1 week remains lower in the cryoablation group. This is a promising result, which has not yet been described before.…”

Section: Opioid Usementioning

confidence: 55%

“…3,6 Others used gabapentin only on indication. 2,5 However, all studies reported a low incidence of neuropathic pain. In our population gabapentin (300 mg, twice daily for five days) was prescribed postoperatively in all patients weighing >40 kilograms in the CEA group and in six patients in the cryoablation group.…”

Section: Neuropathic Pain and Gabapentin Usementioning

confidence: 99%

“…The LOS was 3 days shorter in the cryoablation group, which is similar to the literature (LOS varying from À2 to À3 days). [3][4][5]8 Since cryoablation was implemented after years of providing extensive multimodal pain therapy, requiring long hospitalization, patients in the cryoablation cohort might have been hospitalized for too long. An analgesic regimen that further reduces opioid use may reduce LOS even further.…”

Section: Losmentioning

confidence: 99%

“…Alone or combined with the standard of care in multimodal pain protocols, it reduces postoperative opioid use and LOS. 2,4,5 However, uncertainties remain regarding long-term complications, particularly neuropathic pain (for which prophylactic gabapentin is used). Although there is abundance of studies, pain scores in the only randomized controlled trial did not differ between cryoanalgesia and CEA.…”

Section: Introductionmentioning

confidence: 99%

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Intercostal Nerve Cryoablation or Epidural Analgesia for Multimodal Pain Management after the Nuss Procedure: A Cohort Study

van Braak,

de Beer,

de Jong

et al. 2024

Eur J Pediatr Surg

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Background Nuss procedure for pectus excavatum is a minimally invasive, but painful procedure. Recently, intercostal nerve cryoablation has been introduced as a pain management technique. Materials and methods In this cohort study, we compared the efficacy of multimodal pain management strategies in children undergoing a Nuss procedure. The effectiveness of intercostal nerve cryoablation combined with patient-controlled systemic opioid analgesia (PCA) was compared to continuous epidural analgesia (CEA) combined with PCA. The study was conducted between January 2019 and July 2022. Primary outcome was length of stay (LOS), secondary outcomes were operation room time, postoperative pain, opioid consumption and gabapentin use. Results Sixty-six consecutive patients were included, 33 patients in each group. The cryoablation group exhibited lower Numeric Rating Scale (NRS) pain scores on postoperative day one and two (p=.002, p=.001) and a shorter LOS (three versus six days (p<.001)). Cryoablation resulted in less patients requiring opioids at discharge (30.3% versus 97.0% (p<.001)) and one week after surgery (6.1% versus 45.4% (p<.001)). In the CEA group gabapentin use was more prevalent (78.8% versus 18.2%, p<.001) and the operation room time was shorter (119.4 versus 135.0 minutes (p<.010)). No neuropathic pain was reported. Conclusions Intercostal nerve cryoablation is a superior analgesic method compared to CEA, with reduced LOS, opioid use and NRS pain scores. The prophylactic use of gabapentin is redundant.

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“…The LOS was three days shorter in the cryoablation group, which is similar to the literature (LOS varying from -2 to -3 days) [3][4][5]8 .…”

Section: Lossupporting

confidence: 88%

Section: Opioid Usementioning

confidence: 55%