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Implementation of a Cryoablation-based Pain Management Protocol for Pectus Excavatum
Hannah C Cockrell1, Jennifer Hrachovec2, Jamie Schnuck3
1Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA, 98195, USA.
Implementing intercostal nerve cryoablation (INC) for pectus excavatum repair significantly reduced postoperative pain, hospital stay, and opioid use compared to bupivacaine catheters. This improved patient outcomes and reduced side effects.
Area of Science:
- Thoracic surgery
- Pain management
- Pediatric surgery
Background:
- The Nuss procedure for pectus excavatum often results in severe postoperative pain.
- Standardized pain management protocols are crucial for optimizing patient recovery.
- This study evaluates an institutional protocol for pectus excavatum pain management.
Purpose of the Study:
- To assess the effectiveness of a standardized pain management protocol for pectus excavatum repair.
- To compare patient outcomes between bupivacaine soaker catheters and intercostal nerve cryoablation (INC).
- To analyze the impact of protocol implementation on pain scores, length of stay, and opioid consumption.
Main Methods:
- A retrospective analysis of 244 pectus excavatum patients undergoing Nuss repair.
- Implementation of two pain management protocols: bupivacaine soaker catheters (PI1) and INC (PI2).
- Patient outcomes tracked using statistical process control charts and run charts; demographic differences assessed via Chi-squared tests.
Main Results:
- Hospital length of stay decreased from 4.1 to 2.4 days with INC.
- Maximum postoperative pain scores improved in the PACU and within 24 hours post-op.
- Average opioid dosing (morphine equivalents) decreased by over 50%, reducing nausea and constipation.
Conclusions:
- Intercostal nerve cryoablation (INC) is superior to bupivacaine soaker catheters for pectus excavatum pain management.
- The implemented protocol using INC significantly reduced hospital length of stay and immediate postoperative pain.
- INC led to decreased opioid requirements, nausea, and constipation, enhancing overall patient recovery.
