Use of transthoracic cryoanalgesia during the Nuss procedure

Kim, Sung Hoon; Idowu, Olajire; Palmer, Barnard J.A.; Lee, Sang H.

doi:10.1016/j.jtcvs.2015.09.110

Cited by 46 publications

(15 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3,5,6 Similarly, the application of thoracoscopic cryoanalgesia has been able to provide long-lasting pain control, decreased hospital stay, and reduced opioid use, as reflected in the series published so far. 2,4,[17][18][19][20][21][22][23] With the aim of further improving the use of cryotherapy and avoiding possible complications related to thoracoscopy, 21 we applied ultrasound-guided percutaneous cryotherapy prior to the Nuss procedure obtaining encouraging results in terms of hospital stay, pain, and opioid use. Since the effect of cryotherapy begins approximately 6 to 10 hours after application and in some studies even exceeds 24 hours, we wanted to optimize the procedure by performing it 48 hours prior to the shorter hospital stay (LOS) and with less use of opioids and less pain, which were significant findings.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

View full text Add to dashboard Cite

show abstract

“…23 Other retrospective reviews of early results from this method of analgesia have been promising, and further investigation is needed to determine if there are any long-term neurological complications associated with this technique. [24][25][26] Though this technique is gaining in popularity, currently the two most common methods of postoperative pain control in minimally invasive pectus excavatum repair are epidural and PCA. However, published studies examining the effectiveness of these two methods show mixed results.…”

Section: Discussionmentioning

confidence: 99%

Epidural versus PCA Pain Management after Pectus Excavatum Repair: A Multi-Institutional Prospective Randomized Trial

et al. 2019

View full text Add to dashboard Cite

Introduction Postoperative pain control remains the primary reason for inpatient stay after minimally invasive repair of pectus excavatum. In a previous study, our group reported that early pain control was better in patients managed with a thoracic epidural, while late pain control was better in patients managed with patient-controlled analgesia (PCA). After revising our epidural transition and modifying the PCA protocol, we conducted a multi-institutional prospective randomized trial to evaluate these two pain control strategies. Materials and Methods Patients were randomized to epidural or PCA following minimally invasive repair of pectus excavatum with standard protocols for each arm. Primary outcome was length of stay with secondary variables including mean patient pain scores, complications, and parental satisfaction. Scores were pooled for the two groups and reported as means with standard deviation. Results were compared using t-tests and one-way analysis of variance with p-value < 0.05 determining significance. Results Sixty-five patients were enrolled, 32 epidural and 33 PCA. Enrollment was stopped early when we developed an alternative strategy for controlling these patients' pain. There was no difference in length of stay in hours between the two arms; epidural 111.3 ± 18.5 versus PCA 111.4 ± 51.4, p = 0.98. Longer operative time was found in the epidural group. Nine patients in the epidural group (28%) required a PCA in addition to epidural for adequate pain control. Mean pain scores were lower on postoperative day 0 in the epidural group compared with the PCA groups, but were otherwise similar. Conclusion In our prospective randomized trial, PCA is just as effective as thoracic epidural in decreasing early postoperative pain scores after minimally invasive repair of pectus excavatum.

show abstract

“…In the years since the 3MP was conceived, significant research efforts have focused on improving pain control after the Nuss and Ravitch procedures, especially in the areas of multimodal and regional analgesia [14][15][16][17]. We have been especially encouraged by the effects of intraoperative cryoanalgesia, and have recently begun to use it in the Nuss procedure at our institution [18].…”

Section: Discussionmentioning

confidence: 99%

Magnetic Mini-Mover Procedure for pectus excavatum IV: FDA sponsored multicenter trial

Graves

Hirose

Raff

et al. 2017

Journal of Pediatric Surgery

View full text Add to dashboard Cite

show abstract

Use of transthoracic cryoanalgesia during the Nuss procedure

Abstract: Use of Cryoprobe for Nuss procedure. Central Message We describe a thoracoscopic transthoracic cryoanalgesia technique during the Nuss procedure.

Cited by 46 publications

References 4 publications

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

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

Epidural versus PCA Pain Management after Pectus Excavatum Repair: A Multi-Institutional Prospective Randomized Trial

Magnetic Mini-Mover Procedure for pectus excavatum IV: FDA sponsored multicenter trial

Contact Info

Product

Resources

About