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Intercostal Nerve Cryoablation During Pectus Excavatum Surgery for Postoperative Pain Management: A Systematic Review
David M Notrica1,2,3, Lisa E McMahon1,2,3, Alyssa Hahn4
1Phoenix Children's Division of Pediatric Surgery, 1919 East Thomas Road, Phoenix, AZ 85016, USA.
Annals of Surgery
|July 28, 2025
Summary
Intercostal nerve cryoablation (CRYO) during pectus excavatum (PEx) repair significantly reduces hospital stay and opioid use. This pain management technique offers a safe and effective alternative for patients undergoing PEx surgery.
Area of Science:
- Thoracic surgery
- Pain management
- Minimally invasive procedures
Background:
- Pectus excavatum (PEx) repair, using Nuss or Ravitch procedures, causes significant postoperative pain.
- Intercostal nerve cryoablation (CRYO) is increasingly used as a non-opioid pain management strategy during PEx repair.
Purpose of the Study:
- To systematically review and compare outcomes of CRYO versus standard care (non-CRYO) after PEx repair.
- To evaluate the impact of CRYO on hospital length of stay (LOS) and opioid consumption.
Main Methods:
- A systematic literature search was conducted in PubMed and Embase (2014-2024).
- Meta-analysis quantitatively assessed LOS and opioid consumption.
- Secondary outcomes included hospital costs and complications, qualitatively summarized.
Main Results:
- 32 comparative studies (13,103 patients) were included; 28% received CRYO.
- CRYO significantly shortened LOS by 1.8 days.
- CRYO reduced inpatient and outpatient opioid consumption by 186 MME and 147 MME, respectively.
- Complications were infrequent and similar or decreased with CRYO; hospital costs were comparable.
Conclusions:
- CRYO during PEx repair is associated with significantly shorter hospital LOS.
- CRYO effectively decreases opioid consumption both during hospitalization and post-discharge.
- CRYO is a safe adjunct for pain management in PEx repair, with infrequent and time-limited complications.
Keywords:
Nuss procedurecomplicationsintercostal nerve cryoablationmeta-analysispain managementpectus excavatum repairMore Related Videos
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