C. E. Clinker1, J. H. Scaife1, R. S. Eldredge3, K. W. Russell2 1University Of Utah, School Of Medicine, Salt Lake City, UT, USA 2University Of Utah, Department Of Surgery, Salt Lake City, UT, USA 3Mayo Clinic In Arizona, Department Of Surgery, Phoenix, AZ, USA
Introduction:
The use of intercostal nerve cryoablation (INC) during the minimally invasive repair of pectus excavatum (MIRPE) has been previously shown to decrease the length of stay (LOS) and inpatient opioid use when compared to other analgesic strategies. Our institution previously utilized paravertebral nerve blocks placed in the operating room as the main modality of pain control; however, we recently transitioned to utilizing INC for pain control following MIRPE. The aim of this study was to determine how INC affected the operative time, outpatient prescription of opioids, and complication rates at a single center compared to the paravertebral nerve block strategy.
Methods:
A retrospective review was performed at a single tertiary pediatric referral center of all patients who underwent MIRPE between 2018-2023. Patient demographics and factors, operative details, and perioperative course, including any complications prior to Nuss bar removal, were collected. The use of INC versus paravertebral nerve blocks was recorded. To measure the differences in cohorts, univariate analyses were performed using Wilcoxon rank sum tests for continuous variables and chi-squared tests for categorical variables.
Results:
A total of 200 patients were included (median age: 15 years [IQR:14,16]; median BMI: 18.41 kg/m2 [IQR: 17.13,19.69]; median Haller index 4.40 [IQR: 3.84, 5.45]) of which 32% (64/200) received INC, and 68% (136/200) received a paravertebral nerve block with MM. The INC and paravertebral nerve block cohorts did not differ significantly in age, BMI, or Haller index. The use of INC was associated with an increased operative time (INC: 92 min [IQR: 81, 107] vs paravertebral nerve block: 67 min [IQR: 60, 83], p<0.001); however, INC was associated with a 3 fold decrease in the amount of opioids prescribed at discharge (INC: 52 mg oral morphine equivalents (OME) [IQR:33,83] vs paravertebral nerve block 177 mgOME [ IQR:100, 238], p<0.001). Also, INC was associated with a 1 day-decreased LOS.
Conclusion:
INC during the MIRPE is a safe modality for pain control with minimal morbidity. While the use of INC increases the operative time, it is associated with a 2-fold decrease in the amount of opioids prescribed at discharge compared to a paravertebral approach.
