Impact of 2-site cryoablation on pain control after the Nuss procedure

Intercostal nerve cryoablation (cryo) reduces opioid use and hospital length of stay (LOS) following the Nuss procedure. Traditionally, cryoablation targets only the main branch of the intercostal nerve (ICN). A 2-site technique has been proposed to additionally target the collateral ICN branch, potentially improving postoperative analgesia.

We retrospectively analyzed patients ≤21 years of age who underwent the Nuss procedure with the Park System from 01/2023 to 01/2026. Group 1 underwent standard single-site cryoablation inferior to the rib, targeting the main ICN (1-site cryo). Group 2 underwent two-site cryoablation with an additional freeze at the superior aspect of the rib below, targeting both the main ICN and collateral branch (2-site cryo). Postoperative pain scores, opioid utilization (IV and oral morphine equivalents [OME]), and hospital LOS were compared.

Eighty-two patients were included: 43 (52.4%) received 1-site cryo and 39 (47.6%) received 2-site cryo. Groups were similar in demographics, bar number, and deformity severity (mean Haller Index 4.9 vs 4.4, p = 0.09). There was no change in the average in-house, postoperative pain score (1-site: 2.9 ± 1.7 vs. 2-site: 2.2 ± 1.4, p = 0.1), but lowest pain scores were significantly improved (1-site: 0.4 ± 1.2 vs. 2-site: 0.0 ± 0.0, p = 0.03). In addition, there were no significant differences in postoperative IV opioid use (21.0 ± 36.4 vs 13.0 ± 15.9 OME, p = 0.81), oral opioid use (50.9 ± 48.7 vs 46.4 ± 32.3 OME, p = 0.98), or LOS (31.8 ± 20.6 vs 28.8 ± 12.2 h, p = 0.75).

2-site cryoablation produces modest numerical reduction in average pain scores and statistically significant reduction in lowest pain scores which did not translate into statistically significant differences in opioid consumption or hospital length of stay. Further studies of 2-site CRYO with larger study groups may be better powered to detect smaller improvements in these parameters.