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Published on: February 26, 2013
Intercostal Nerve Cryoablation in Minimally Invasive Repair of Pectus Excavatum: Effect on Pulmonary Function
Krista Lai1, Justin Lee1,2,3, David M Notrica1,2,3
1Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA.
Abstract:
Cryoablation of intercostal nerves is performed for pain control after minimally invasive repair of pectus excavatum (MIRPE). Cryoablation affects both sensory and motor neurons, resulting in temporary anesthesia to the chest wall and loss of intercostal motor function. The study objective is to determine the effect of cryoablation on incentive spirometry (IS) volumes, as a measure of pulmonary function, after MIRPE. A single-institution retrospective review of pediatric patients undergoing MIRPE was performed. All patients received a multimodal regimen (MMR) of analgesics postoperatively. Three groups were compared-cryoablation (CRYO), elastomeric pain pump (EPP), and MMR alone. The primary outcomes were postoperative IS volumes and IS volumes as a ratio of preoperative forced vital capacity (FVC). Secondary outcomes included pain scores, opioid use, length of stay (LOS), and infectious complications. MIRPE was performed in 115 patients: 50 CRYO, 50 EPP, and 15 MMR alone. Groups were similar for demographics and pectus excavatum severity. Postoperative spirometry measurements were similar across groups: IS (CRYO 750 mL [500,961] versus EPP 750 mL [590,1019] versus MMR 696 mL [500,1037], P = .77); IS/FVC (CRYO 0.19 [0.14,0.26] versus EPP 0.20 [0.16,0.26] versus MMR 0.16 [0.15,0.24], P = .69). Although pain scores were also similar across groups, CRYO patients used less opioid (P < .05) and had shorter LOS (P < .05). Postoperative pneumonia was rare and similar across groups (P = 1.00). Intercostal nerve cryoablation during MIRPE does not adversely affect postoperative IS volumes or increase pneumonia rate, despite the temporary loss of motor innervation to intercostal muscles. Cryoablation provides effective pain control with less opioid use.
Insights
Cryoablation of intercostal nerves after minimally invasive repair of pectus excavatum (MIRPE) does not impact pulmonary function. This pain management technique effectively reduces opioid use and length of stay without increasing pneumonia risk.
Area of Science:
- Thoracic surgery
- Pain management
- Pulmonary function testing
Background:
- Minimally invasive repair of pectus excavatum (MIRPE) often requires effective postoperative pain control.
- Cryoablation of intercostal nerves is used for pain management post-MIRPE, temporarily affecting sensory and motor neurons.
- The impact of cryoablation on pulmonary function, specifically incentive spirometry (IS) volumes, after MIRPE is not well-established.
Purpose of the Study:
- To determine the effect of intercostal nerve cryoablation on postoperative incentive spirometry (IS) volumes following MIRPE.
- To compare pulmonary function, pain scores, opioid consumption, length of stay, and infectious complications between cryoablation, elastomeric pain pump, and multimodal pain management alone.
Main Methods:
- A retrospective review of pediatric patients who underwent MIRPE was conducted.
- Patients were divided into three groups: cryoablation (CRYO), elastomeric pain pump (EPP), and multimodal regimen (MMR) alone.
- Primary outcomes included postoperative IS volumes and IS/forced vital capacity (FVC) ratio; secondary outcomes included pain, opioid use, length of stay, and complications.
Main Results:
- Postoperative IS volumes and IS/FVC ratios were similar across all three groups (CRYO, EPP, MMR).
- Cryoablation patients reported similar pain scores but demonstrated significantly reduced opioid use and shorter length of stay compared to other groups.
- The incidence of postoperative pneumonia was low and comparable among the groups.
Conclusions:
- Intercostal nerve cryoablation during MIRPE does not adversely affect postoperative pulmonary function as measured by IS volumes.
- Cryoablation is an effective pain management strategy post-MIRPE, associated with decreased opioid requirements and shorter hospital stays.
- Cryoablation can be safely employed for pain control after MIRPE without increasing the risk of pulmonary complications.
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