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Time to spare: 1-Minute vs 2-minute intercostal nerve cryoablation during minimally invasive repair of pectus
Ryan Hare1, Stephanie F Brierley1, Rebecca Payne1
1Division of Pediatric Surgery, Phoenix Children's, 1919 E Thomas Rd, Phoenix, AZ, 85016, USA.
Background:
Intercostal nerve cryoablation (INC) during minimally invasive repair of pectus excavatum (MIRPE) reduces postoperative opioid use and hospital length of stay. However, few studies have directly evaluated optimal duration of cryoprobe application. This study compared postoperative outcomes following 1-min versus 2-min INC during MIRPE.
Methods:
A single-center retrospective study was conducted on patients ≤21 years old who underwent MIRPE with INC between 2023 and 2025. Cryoablation was performed thoracoscopically for either 2 min per nerve using the cryoICE® cryoSPHERE+® or 1 min per nerve using the cryoICE® cryoSPHERE® MAX probe. Demographics, operative characteristics, and postoperative outcomes were compared between groups.
Results:
Among 164 patients, 87 (53%) received 2-min of INC and 77 (47%) received 1-min of INC. Patient age, sex, BMI, and Haller Index were similar between groups. Correction Index was greater in the 2-min group (38% vs 32%, p = 0.005). Operative time was significantly shorter in the 1-min INC group (137 vs 170 min, p < 0.001). Average inpatient pain scores were slightly higher in the 1-min INC group (3.5 vs 3.1, p < 0.05), but inpatient opioid usage was similar (0.203 vs 0.178 OME/kg). Total opioid prescriptions at discharge were lower (p < 0.001) with no difference in opioid refill rates, thirty-day emergency department visits, and readmissions compared to the 2-min INC group.
Conclusion:
Reducing INC duration from 2 min to 1 min during MIRPE does not adversely affect postoperative analgesic outcomes and significantly shortens operative time. One-minute intercostal nerve cryoablation appears to provide effective analgesia.
Insights
One-minute intercostal nerve cryoablation (INC) during minimally invasive repair of pectus excavatum (MIRPE) effectively reduces operative time without compromising postoperative pain control. This shorter INC duration offers a safe and efficient alternative for pain management in MIRPE patients.
Area of Science:
- Thoracic Surgery
- Pediatric Surgery
- Pain Management
Background:
- Intercostal nerve cryoablation (INC) is utilized during minimally invasive repair of pectus excavatum (MIRPE) to decrease opioid consumption and hospital stay.
- Optimal cryoprobe application duration for INC during MIRPE remains under investigation.
Purpose of the Study:
- To compare postoperative outcomes between one-minute and two-minute INC durations in pediatric patients undergoing MIRPE.
- To evaluate the impact of INC duration on operative time, pain scores, and opioid utilization.
Main Methods:
- A retrospective study analyzed 164 patients (≤21 years) who underwent MIRPE with INC.
- Patients received either one-minute or two-minute cryoablation per nerve using different cryoprobe models.
- Demographics, operative characteristics, and postoperative outcomes were compared between the two groups.
Main Results:
- The one-minute INC group had significantly shorter operative times (137 vs. 170 minutes) and a lower Correction Index (32% vs. 38%).
- Inpatient pain scores were slightly higher in the one-minute INC group, but inpatient opioid usage was similar.
- Total opioid prescriptions at discharge were lower in the one-minute INC group, with no differences in readmissions or ED visits.
Conclusions:
- Reducing INC duration to one minute during MIRPE is safe and effective for analgesia.
- One-minute INC significantly shortens operative time without negatively impacting postoperative pain management.
- Shorter INC duration presents an efficient alternative for pain management in MIRPE.
