C. Harbaugh1, K. N. Johnson1, M. D. Jarboe1, R. B. Hirschl1, J. D. Geiger1, S. K. Gadepalli1 1University Of Michigan,C.S. Mott Children’s Hospital, Section Of Pediatric Surgery,Ann Arbor, MI, USA
Introduction: Video-assisted intercostal nerve cryoablation (INC) during minimally invasive repair of pectus excavatum (Nuss procedure) in adolescents may decrease postoperative pain, opioid use, and length of stay. We sought to evaluate intraoperative and postoperative outcomes in comparison to thoracic epidural (TE) at our center.
Methods: We retrospectively reviewed the hospital course of adolescent patients who underwent Nuss procedure with INC (n=19) or TE (n=13) from January 1, 2015 – August 15, 2017. We compared both groups with respect to patient demographics, postoperative complications, opioid (including oral and intravenous opioids, excluding intrathecal), and non-opioid pain medications (nonsteroidal anti-inflammatories, acetaminophen, and muscle relaxants). The primary outcome was length of stay and secondary outcomes were opioid use and complication rate. All opioid doses were converted to oral morphine equivalents (OME) in milligrams. Mann-Whitney U was used to compare medians, and chi-squared for postoperative complications.
Results: The mean age was 16.7 ± 2.0 years old and 86% of the patients were male. Haller Index was significantly higher in INC compared to TE (4.3±1.3 vs. 3.4±0.9, p=0.03), with no other significant differences in demographics. Length of stay was significantly shorter for INC as compared to TE (median (IQR): 4 (3-4) days vs 6 (4-6) days; p<0.001). Intraoperative opioids (75(48–87) OME vs 30(15–30) OME; p=0.003) and immediate postoperative intravenous opioids (77.4 (63.2–171.1) OME vs 0 (0–36) OME; p<0.001) were significantly higher in INC as compared to TE; however, opioid use at discharge were decreased (200 (200 – 266.7) OME; 266.7 (266.7–400) OME; p=0.024). There was no difference in postoperative complications (21.1% vs. 38.5%, p=0.28).
Conclusion: INC during Nuss procedure reduced length of stay and discharge opioid pain medications, but increased intraoperative and postoperative IV opioid requirements. This opioid trend may reflect the need for improved pain control until INC takes effect, when long-term pain control improves. Prospective evaluation of INC including neuropathy and costs will be necessary prior to recommending routine use with all Nuss procedures.
