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Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
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Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
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Related Experiment Video

Updated: Nov 15, 2025

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Same day discharge for pectus excavatum-is it possible?

R Luke Rettig1, Andrew G Rudikoff2, Hoi Yee Annie Lo1

  • 1Department of Pediatric Surgery, Kaiser Permanente Los Angeles Medical Center, 4867 Sunset Blvd. Los Angeles 90027, CA, United States.

Journal of Pediatric Surgery
|March 8, 2021
PubMed
Summary

Same day discharge is safe for pectus excavatum patients after Nuss procedures using intercostal nerve cryoablation and block. This approach effectively manages pain, allowing for early patient recovery and reduced hospital stays.

Keywords:
Enhanced recovery after surgery (ERAS)Intercostal nerve cryoablationPectus excavatum repairSame day discharge

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Area of Science:

  • Pain Management
  • Thoracic Surgery
  • Surgical Outcomes

Background:

  • Pectus excavatum (PE) repair, particularly the Nuss procedure, often involves significant postoperative pain.
  • Intercostal nerve cryoablation (INC) and intercostal nerve block (INB) are established pain management techniques for PE surgery.
  • Enhanced Recovery After Surgery (ERAS) protocols aim to optimize patient recovery and reduce hospital length of stay.

Purpose of the Study:

  • To evaluate the feasibility and safety of same-day discharge for PE patients undergoing the Nuss procedure with INC and INB.
  • To assess the impact of INC and INB on postoperative pain control and complications in PE patients.

Main Methods:

  • Prospective study of 15 consecutive PE patients undergoing Nuss repair with INC, INB, and an ERAS protocol.
  • Primary outcome: hospital length of stay (LOS) in hours.
  • Secondary outcomes: same-day discharge rates, postoperative complications, ED/UC visits, opioid use, and return to OR.

Main Results:

  • Average LOS was 11.9 hours.
  • 66.7% of patients were discharged on postoperative day 0.
  • No patients were hospitalized due to pain; complications like urinary retention or drowsiness, not pain, led to delayed discharge in some cases.
  • 66.7% of patients did not require opioids post-discharge.

Conclusions:

  • Same-day discharge is a safe and feasible option for PE patients undergoing Nuss procedures with INC and INB.
  • INC combined with INB provides effective pain control with minimal complications.
  • Early discharge can be safely considered for PE patients managed with this multimodal pain approach.