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Zeineddin S, Goldstein SD, Linton S, DeBoer C, Alayleh A, Ortiz I, Sands L, Kujawa S, Suresh S, Ghomrawi H, Abdullah F. Effectiveness of one minute per level intercostal nerve cryoablation for postoperative analgesia after surgical correction of pectus excavatum. J Pediatr Surg 2023; 58:34-40. [PMID: 36283847 DOI: 10.1016/j.jpedsurg.2022.09.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/16/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Intraoperative intercostal nerve cryoablation has emerged as a promising modality for postoperative analgesia following Surgical Correction of Pectus Excavatum (SCOPE). Most centers use two-minute cryoablation per level, although data from histologic and adult studies suggest the effectiveness of one-minute freezes. We aimed to describe our center's experience with one minute per level cryoablation. METHODS A retrospective single institution review of patients undergoing SCOPE was performed to compare patients pre- and post-intercostal nerve cryoablation implementation. Cryoablation was performed as one minute for each of the thoracic intercostal nerves T3-T7. Multivariable regression analyses were conducted to compare the outcomes and cost between pre- and post-implementation groups. RESULTS During the study period, 198 patients underwent SCOPE with one Nuss bar, receiving either intraoperative intercostal nerve cryoablation (Cryo, n = 100) or preoperative thoracic paravertebral catheters (NoCryo, n = 98). Surgical time was on average 9 min longer for the Cryo group (p<0.01). Median length of stay for the Cryo group was 3 days shorter compared to the NoCryo group (p<0.01). The Cryo group had a 19-fold and 5.6-fold reduction in average inpatient and total postoperative opioid usage, respectively (p<0.01). Total hospital costs were significantly lower in the Cryo group (p<0.01). Overall complication rate was not statistically significant different between the two groups. CONCLUSIONS Intraoperative one minute per level cryoablation is a potent approach to postoperative analgesia for SCOPE patients that led to a shorter hospital length of stay, lower hospital costs, and decreased opioid use compared to conventional analgesia at our institution. Pediatric surgeons performing correction of chest wall deformities should consider offering this technique.
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Affiliation(s)
- Suhail Zeineddin
- Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USA; Department of Surgery, Northwestern University, Chicago, IL, USA
| | - Seth D Goldstein
- Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USA; Department of Surgery, Northwestern University, Chicago, IL, USA
| | - Samuel Linton
- Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USA; Department of Surgery, Northwestern University, Chicago, IL, USA
| | - Christopher DeBoer
- Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USA; Department of Surgery, Northwestern University, Chicago, IL, USA
| | - Amin Alayleh
- Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USA
| | - Irma Ortiz
- Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USA
| | - Laurie Sands
- Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USA
| | - Suzanne Kujawa
- Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USA
| | - Santhanam Suresh
- Department of Pediatric Anesthesia, Children's Hospital of Chicago, Chicago, IL, USA
| | - Hassan Ghomrawi
- Department of Surgery, Northwestern University, Chicago, IL, USA; Department of Pediatrics, Northwestern University, Chicago, IL, USA
| | - Fizan Abdullah
- Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USA; Department of Surgery, Northwestern University, Chicago, IL, USA.
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Fraser JA, Briggs KB, Svetanoff WJ, Aguayo P, Juang D, Fraser JD, Snyder CL, Oyetunji TA, St Peter SD. Short and long term outcomes of using cryoablation for postoperative pain control in patients after pectus excavatum repair. J Pediatr Surg 2022; 57:1050-1055. [PMID: 35277249 DOI: 10.1016/j.jpedsurg.2022.01.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/31/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We report the findings of a three-year prospective observational study elucidating long-term symptoms and complications of patients who underwent minimally invasive pectus excavatum repair with intercostal nerve cryoablation with specific attention to postoperative pain control associated with the cryoablation technique. METHODS Surveys were administered to patients who underwent bar placement for pectus excavatum with intercostal nerve cryoablation from 2017 to 2021 regarding pain scores, pain medication usage, and limitations to activity beginning on the day of surgery, on the day of discharge, and at two-week and three-month follow-up. RESULTS Of 110 patients, forty-eight (44%) completed the discharge survey; sharp pain and pressure on the first postoperative night were the most described pain characteristics, most frequently in the middle of the chest. On follow-up, 55% of patients reported tolerable residual pain at two weeks and 41% at three months, with 25% requiring intermittent pain medication at three months. There were three readmissions for inadequate pain control and 110 calls to the surgery clinic by three-month follow-up, most commonly for persistent pain and frequent popping sensation with movement. DISCUSSION Although cryoablation is an excellent pain control modality, these data suggest that patients underreport functional symptoms and experience more frequent discomfort and alteration of daily living activities.
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Affiliation(s)
- James A Fraser
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA
| | - Kayla B Briggs
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA
| | - Wendy Jo Svetanoff
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA; Department of Surgery, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road Kansas City, Kansas City, MO 64108, USA
| | - David Juang
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA; Department of Surgery, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road Kansas City, Kansas City, MO 64108, USA
| | - Jason D Fraser
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA; Department of Surgery, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road Kansas City, Kansas City, MO 64108, USA
| | - Charles L Snyder
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA; Department of Surgery, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road Kansas City, Kansas City, MO 64108, USA
| | - Tolulope A Oyetunji
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA; Department of Surgery, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road Kansas City, Kansas City, MO 64108, USA
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA; Department of Surgery, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road Kansas City, Kansas City, MO 64108, USA.
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Sun RC, Mehl SC, Anbarasu CR, Portuondo JI, Espinoza AF, Whitlock R, Mazziotti MV. Intercostal cryoablation during Nuss procedure: A large volume single surgeon's experience and outcomes. J Pediatr Surg 2021; 56:2229-2234. [PMID: 33853732 DOI: 10.1016/j.jpedsurg.2021.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/09/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent studies have shown intercostal cryoablation(IC) during the Nuss procedure decreases hospital length of stay(LOS) and opioid administration. However, few studies have also evaluated the risk of postoperative complications related to IC. METHODS We performed a single center retrospective analysis of all patients who underwent Nuss procedure by one surgeon from 2/2016 to 2/2020, comparing intraoperative IC to other pain management modalities(non-IC). Primary outcomes were postoperative complications, hospital LOS, and opioid administration. Multivariate analysis was performed with outcomes reported as regression coefficients(RC) or odds ratios(OR) with 95% confidence interval. RESULTS IC was associated with decreased hospital LOS (RC -1.91[-2.29 to -1.54], less hospital opioid administration (RC -4.28[-5.13 to -3.43]), and less discharge opioid administration (RC -3.82[-5.23 to -2.41]). With respect to postoperative complications, IC decreased the odds of urinary retention (OR 0.16[0.06 to 0.44]); however, increased the odds of slipped bars requiring reoperation (OR 36.65[5.04-266.39]). CONCLUSIONS Our single surgeon experience controls for surgeon variability and demonstrates intraoperative IC for the Nuss procedure is an effective pain management modality that decreases hospital LOS and opioid use during hospitalization and at discharge; however, it is associated with increased odds of slipped bars requiring reoperation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Raphael C Sun
- Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States; Department of Surgery, Baylor College of Medicine, Houston, TX, United States.
| | - Steven C Mehl
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Centura R Anbarasu
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Jorge I Portuondo
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Andres F Espinoza
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Richard Whitlock
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Mark V Mazziotti
- Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States; Department of Surgery, Baylor College of Medicine, Houston, TX, United States
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