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IMPACT OF 2-SITE CRYOABLATION ON PAIN CONTROL AFTER THE NUSS PROCEDURE
Cecilia Gigena Heitsman1, Jason O Robertson1, Rajkamal Vishnu Sudha Krishnagopal1
1Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Journal of Pediatric Surgery
|July 30, 2026
Summary
Two-site intercostal nerve cryoablation (cryo) for Nuss procedure offers a statistically significant reduction in lowest pain scores. However, this technique did not significantly decrease overall opioid use or hospital length of stay compared to standard cryoablation.
Area of Science:
- Thoracic Surgery
- Pain Management
- Minimally Invasive Procedures
Background:
- Intercostal nerve cryoablation (cryo) is utilized to reduce opioid consumption and hospital length of stay (LOS) post-Nuss procedure.
- The traditional approach targets only the main intercostal nerve (ICN) branch.
- A novel 2-site cryoablation technique aims to improve postoperative analgesia by additionally targeting the ICN collateral branch.
Purpose of the Study:
- To compare the efficacy of standard 1-site intercostal nerve cryoablation versus a novel 2-site technique in patients undergoing the Nuss procedure.
- To evaluate the impact of 2-site cryoablation on postoperative pain scores, opioid utilization, and hospital LOS.
Main Methods:
- Retrospective analysis of patients (≤21 years) who underwent the Nuss procedure with the Park System between 01/2023 and 01/2026.
- Patients were divided into two groups: 1-site cryoablation (targeting main ICN) and 2-site cryoablation (targeting main and collateral ICN branches).
- Comparison of postoperative pain scores, intravenous and oral opioid utilization (morphine equivalents), and hospital LOS between the two groups.
Main Results:
- Eighty-two patients were analyzed (43 in 1-site group, 39 in 2-site group).
- The 2-site cryoablation group showed a statistically significant improvement in lowest pain scores (p=0.03) but no significant change in average pain scores (p=0.1).
- No significant differences were observed in postoperative opioid consumption (IV and oral) or hospital LOS between the 1-site and 2-site cryoablation groups.
Conclusions:
- Two-site cryoablation demonstrates a modest numerical reduction in average pain scores and a statistically significant reduction in lowest pain scores following the Nuss procedure.
- These improvements did not translate into statistically significant reductions in opioid consumption or hospital length of stay.
- Larger studies are warranted to better evaluate the potential benefits of 2-site cryoablation for these outcomes.
