Next day discharge after the Nuss procedure using intercostal nerve cryoablation, intercostal nerve blocks, and a perioperative ERAS pain protocol

Ultrasound-Guided Percutaneous Cryoanalgesia for Pectus Excavatum: When Should It be Applied?

“…29 Our idea is to go a step further and eliminate PCA from the postoperative protocol in patients with CPr, to verify the decrease in adverse effects of opioids, reduction of hospital stay and, therefore, hospital costs. This idea is in line with the protocols established by Rettig et al or Di Fiore et al 30,31 Finally, percutaneous ultrasound-guided cryoanalgesia (PCr) contributes to the acquisition of skills for its potential use in other pediatric surgical interventions requiring short-and longterm pain control (painful burns of long evolution, rib fractures, palliative process, and lung transplantation...). 14,15,[32][33][34][35][36][37][38][39][40] The main limitation of our study was the small sample size, especially in the PCr24 group.…”

The management of pectus excavatum in pediatric patients: a narrative review

“…The use of INC in the context of multimodal pain control protocols including intercostal nerve blocks has recently been used to allow same- and next-day discharge after MIRPE. The wide adoption of INC was limited by concerns of long term neuropathy after axon regeneration ( 80 , 81 ). In a recent retrospective study of 43 patients who underwent INC during MIRPE, none of the patients under 21 years of age experienced neuropathic pain, while 3 of 13 adults in the study experienced neuropathic pain or prolonged numbness ( 82 ).…”

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 .…”

“…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 95 . Although this mechanism has been known for decades, cryoanalgesia probes became commercially available and approved by the FDA in 2015, sparking a relatively recent increase in use for procedures with increased intercostal mediated pain, such as thoracotomy and chest wall procedures 92,94–97 . These studies have generally shown significant decreases in-hospital length of stay and opioid consumption without affecting pain scores 92,94,95,97 .…”

“…Although this mechanism has been known for decades, cryoanalgesia probes became commercially available and approved by the FDA in 2015, sparking a relatively recent increase in use for procedures with increased intercostal mediated pain, such as thoracotomy and chest wall procedures 92,94–97 . These studies have generally shown significant decreases in-hospital length of stay and opioid consumption without affecting pain scores 92,94,95,97 . However, long-term outcomes, such as neuropathic pain and effectiveness, on other nerves need more investigation.…”