Postoperative pain control modalities for pectus excavatum repair: A prospective observational study of cryoablation compared to results of a randomized trial of epidural vs patient-controlled analgesia

Dekonenko, Charlene; Dorman, Robert M.; Duran, Yara K.; Juang, David; Aguayo, Pablo; Fraser, Jason D.; Oyetunji, Tolulope A.; Snyder, Charles L.; Holcomb, George; Millspaugh, Daniel L.; Peter, Shawn D. St.

doi:10.1016/j.jpedsurg.2019.09.021

Cited by 52 publications

(38 citation statements)

References 16 publications

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“…Cryoanalgesia creates wallerian degeneration without interrupting the myelin sheath and endoneurium, so we prefer the term of "cryoanalgesia" to the term "cryoablation" often reported in the literature and suggesting the (wrong) idea of removing something. Cryoanalgesia proved to be useful in terms of reduction of opioid consumption and hospital stay in previous experiences in North and South America [US (9)(10)(11)(12) and Argentina (13)]. Our experience is consistent with the other reported experiences, even if the protocols adopted and the cryogenic systems used are different from place to place.…”

Section: Discussionsupporting

confidence: 89%

“…According to the recent literature on cryoanalgesia in MIRPE, published from North and South America, cryoanalgesia has the potentiality to reduce analgesic consumption and length of hospitalization, but also to ameliorate persistent pain and facilitate return to normal activity (8)(9)(10)(11)(12)(13). However, the technique of cryoanalgesia was not homogeneous: in the reports available so far, different protocols, probes and different cryogenics systems were used, manufactured by US Companies (©AtriCure, Inc., Mason OH; Frigitronics R , Connecticut).…”

Section: Introductionmentioning

confidence: 99%

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A New Device for Thoracoscopic Cryoanalgesia in Pectus Excavatum Repair: Preliminary Single Center Experience

et al. 2021

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Introduction: Cryoanalgesia has been recently described as alternative technique for immediate and persistent pain treatment after pectus excavatum repair. Cryoanalgesia has the potentiality to reduce analgesic consumption and length of hospitalization. However, cryoanalgesia has not been standardized yet: the previous reports describe different techniques and systems and include only small series. In Europe, no reports on cryoanalgesia for pectus repair have been published so far.Materials and Methods: This is a prospective single center pilot study performed in adolescents undergoing minimally invasive pectus excavatum repair with a new cryoanalgesia system, using a probe designed specifically for thoracoscopy. This new double lumen probe has the theoretical advantage of freezing only in its tip, so reducing the risk of complications.Results: Seven patients undergoing pectus excavatum repair were treated with cryoanalgesia performed with the new probe. No complications of cryoanalgesia were reported. Total consumption of morphine during hospital stay was between 0.1 and 0.35 mg/kg, with no side effects reported. Mean time to discharge was 2.4 days. All patients reported a good pain control with a fair need of rescue medications for pain relief during the first week after discharge, and a very good pain control without need of rescue medications during following weeks.Conclusions: Our pilot study showed that the new cryoanalgesia device is efficacious in terms of pain control, hospital stay and resumption of post-operative activities. The cryoprobe designed allowed an easy and safe maneuver. A prospective trial is needed to better define the risks and benefits of this technique.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

A New Device for Thoracoscopic Cryoanalgesia in Pectus Excavatum Repair: Preliminary Single Center Experience

et al. 2021

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“…In 2020, Dekonenko et al 11 performed a prospective observational study comparing 35 patients undergoing minimally invasive pectus excavatum repair with IC to patients involved in a randomized controlled trial comparing efficacy of epidurals (n=32) versus PCA (n=33). Cryoneurolysis was associated with decreased length of stay (1 day vs. 4.3 and 4.2 days for epidural and PCA groups, p<0.01), less total inpatient MME required (p<0.01), and longer operative time (101 minutes vs. 58 and 57 minutes, p<0.01).…”

Section: Resultsmentioning

confidence: 99%

Efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain after surgery or trauma: systematic review

Péter

Min

Patil

et al. 2021

Trauma Surg Acute Care Open

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BackgroundThere is a critical need for non-narcotic analgesic adjuncts in the treatment of thoracic pain. We evaluated the efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain, specifically addressing the applicability of intercostal cryoneurolysis for pain control after chest wall trauma.MethodsA systematic review was performed through searches of PubMed, EMBASE, and the Cochrane Library. We included studies involving patients of all ages that evaluated the efficacy of intercostal cryoneurolysis as a pain adjunct for chest wall pathology. Quantitative and qualitative synthesis was performed.ResultsTwenty-three studies including 570 patients undergoing cryoneurolysis met eligibility criteria for quantitative analysis. Five subgroups of patients treated with intercostal cryoneurolysis were identified: pectus excavatum (nine studies); thoracotomy (eight studies); post-thoracotomy pain syndrome (three studies); malignant chest wall pain (two studies); and traumatic rib fractures (one study). There is overall low-quality evidence supporting intercostal cryoneurolysis as an analgesic adjunct for chest wall pain. A majority of studies demonstrated decreased inpatient narcotic use with intercostal cryoneurolysis compared with conventional pain modalities. Intercostal cryoneurolysis may also lead to decreased hospital length of stay. The procedure did not definitively increase operative time, and risk of complications was low.ConclusionsGiven the favorable risk-to-benefit profile, both percutaneous and thoracoscopic intercostal cryoneurolysis may serve as a worthwhile analgesic adjunct in trauma patients with rib fractures who have failed conventional medical management. However, further prospective studies are needed to improve quality of evidence.Level of evidenceLevel IV systematic reviews and meta-analyses.

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“…[6][7][8][9][10] Adequate postoperative pain control is the main determinant of hospital stay after the Nuss surgery. [11][12][13] Poor pain control not only increases hospital stay, but also can raise opioid consumption, limit mobility, or favor readmissions. Different strategies have been developed to try to mitigate postoperative pain and its consequences, such as the use of multimodal analgesic therapies, thoracic epidural catheters, elastomeric pain pumps, or intravenous patient-controlled analgesia (PCA), with limited results in the reduction of longterm postoperative pain.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Cryoanalgesia: A New Strategy for Pain Management in Pectus Excavatum Surgery

et al. 2021

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Introduction In recent years, pain protocols for pectus excavatum (PE) have incorporated cryoanalgesia through thoracoscopic approach. Since 2019, ultrasound-guided percutaneous cryoanalgesia (PCr) has been applied at our institution, either on the same day as the Nuss procedure or 48 hours before surgery. We carried out a preliminary retrospective review of patients with PE in whom PCr prior to surgery was performed at our institution between 2019 and 2021. Materials and Methods Two groups were evaluated: PCr on the same day (PCrSD) and PCr 48 hours before surgery (PCr48). Despite PCr, patients were treated with “patient-controlled analgesia” (PCA) with opioids for at least 24 hours, switching to conventional intravenous analgesia and oral analgesia in the following days. Demographic, clinical-radiological variables, PCA opioid use, pain grade according to the visual analog scale (VAS), and length of stay (LOS) were compared between the groups. A total of 20 patients were included (12 with PCrSD and 8 with PCr48), without significant differences in demographics or clinical-radiological variables. The overall median time of PCr was 65 minutes (55–127), with no differences between the groups. Results PCr48 group presented with significantly lower median number of hours of continuous PCA (24 vs. 32 hours; p = 0.031), lower median number of rescue boluses (11 vs. 18; p = 0.042), lower median VAS in the early postoperative hours (2 vs. 5.5; p = 0.043), and lower median LOS (3.5 vs. 5 days). Conclusion PCr performed 48 hours prior to surgery is more effective in terms of PCA requirements, VAS, and LOS when compared with cryoanalgesia on the same day.

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Postoperative pain control modalities for pectus excavatum repair: A prospective observational study of cryoablation compared to results of a randomized trial of epidural vs patient-controlled analgesia

Cited by 52 publications

References 16 publications

A New Device for Thoracoscopic Cryoanalgesia in Pectus Excavatum Repair: Preliminary Single Center Experience

A New Device for Thoracoscopic Cryoanalgesia in Pectus Excavatum Repair: Preliminary Single Center Experience

Efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain after surgery or trauma: systematic review

Percutaneous Cryoanalgesia: A New Strategy for Pain Management in Pectus Excavatum Surgery

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