Implementation of a Cryoablation-based Pain Management Protocol for Pectus Excavatum

Intercostal nerve cryoablation therapy for the repair of pectus excavatum: a systematic review

“…When comparing LOS between patients who had undergone INC vs. TE placement, Keller et al ( 14 ) found that hospital LOS decreased from 5.8 days to 3.4 days. Other researchers have corroborated INCs effect on hospital LOS when compared with TE placement reporting a decreased LOS of 2–3.5 days ( 13 , 28 , 30 , 33 , 34 , 41 , 46 , 48 , 50 , 52 , 54 ). One study found no significant change in LOS when comparing INC with EPP ( 29 ); however, this study was possibly underpowered to find a statistical difference among cohorts, with only six patients receiving INC as part of their care.…”

“…Opioid usage significantly decreased with INC use during MIRPE when compared with other analgesic strategies in all studies that reported opioid consumption ( 13 , 14 , 28 , 30 , 31 , 35 , 37 , 38 , 41 – 43 , 46 , 48 – 51 , 53 , 54 ). A majority of these studies reported opioid use in terms of OME milligrams and reported the total hospital OME milligram; however, most did not account for the LOS in the non-INC cohort when reporting opioid use ( 14 , 28 , 29 , 31 , 35 , 38 , 40 – 43 , 48 , 50 , 51 , 54 ).…”

“…The primary outcome discussed in the majority of the articles was hospital LOS and opioid usage ( Table 2 ). The use of INC was associated with a significant decrease in LOS when compared with other analgesic strategies in 21 out of 22 articles ( 13 , 14 , 28 – 30 , 32 – 38 , 41 – 43 , 46 , 48 – 52 , 54 , 55 ). When comparing LOS between patients who had undergone INC vs. TE placement, Keller et al ( 14 ) found that hospital LOS decreased from 5.8 days to 3.4 days.…”

Pediatric regional anesthesiology: a narrative review and update on outcome-based advances

“…Cryoanalgesia works through rapid focal freezing of nerves, which disrupts axons and induces demyelination. Because demyelination is a time-dependent process, cryoablation is often combined with another immediate-acting analgesic technique, such as LA nerve blocks 91–93 . Core neural structures (epineurium, perineurium, and endoneurium) are left intact, and over time, reinnervation of the nerve through axonal regeneration occurs 93,94 .…”

“…Because demyelination is a time-dependent process, cryoablation is often combined with another immediate-acting analgesic technique, such as LA nerve blocks. [91][92][93] Core neural structures (epineurium, perineurium, and endoneurium) are left intact, and over time, reinnervation of the nerve through axonal regeneration occurs. 93,94 The time required for recovery is proportional to the cryoablation exposure time, 93 and recent studies suggest that reinnervation may occur more rapidly in younger patients than in adults.…”