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CC BY 4.0 · Eur J Pediatr Surg
DOI: 10.1055/a-2249-7588
Original Article

Intercostal Nerve Cryoablation or Epidural Analgesia for Multimodal Pain Management after the Nuss Procedure: A Cohort Study

Hendrik van Braak 
1   Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, AZ, Amsterdam, Noord-Holland, The Netherlands
,
Sjoerd A. de Beer
1   Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, AZ, Amsterdam, Noord-Holland, The Netherlands
,
Justin R. de Jong
1   Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, AZ, Amsterdam, Noord-Holland, The Netherlands
,
Markus F. Stevens
2   Department of Anesthesiology, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
,
Gijsbert Musters
3   Department of Gastrointestinal Surgery and Surgical Oncology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
,
Sander Zwaveling
1   Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, AZ, Amsterdam, Noord-Holland, The Netherlands
,
Matthijs W. N. Oomen
1   Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, AZ, Amsterdam, Noord-Holland, The Netherlands
,
Wendeline Van der Made
4   Department of Surgery, Leiden Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands
,
Egbert Krug
4   Department of Surgery, Leiden Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands
,
L.W. Ernest van Heurn
1   Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, AZ, Amsterdam, Noord-Holland, The Netherlands
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Abstract

Background Nuss procedure for pectus excavatum is a minimally invasive, but painful procedure. Recently, intercostal nerve cryoablation has been introduced as a pain management technique.

Materials and Methods In this cohort study, we compared the efficacy of multimodal pain management strategies in children undergoing a Nuss procedure. The effectiveness of intercostal nerve cryoablation combined with patient-controlled systemic opioid analgesia (PCA) was compared with continuous epidural analgesia (CEA) combined with PCA. The study was conducted between January 2019 and July 2022. Primary outcome was length of stay (LOS), and secondary outcomes were operation room time, postoperative pain, opioid consumption, and gabapentin use.

Results Sixty-six consecutive patients were included, 33 patients in each group. The cryoablation group exhibited lower Numeric Rating Scale (NRS) pain scores on postoperative day 1 and 2 (p = 0.002, p = 0.001) and a shorter LOS (3 vs. 6 days (p < 0.001). Cryoablation resulted in less patients requiring opioids at discharge (30.3 vs. 97.0%; p < 0.001) and 1 week after surgery (6.1 vs. 45.4%; p < 0.001)). In the CEA group, gabapentin use was more prevalent (78.8 vs. 18.2%; p < 0.001) and the operation room time was shorter (119.4 vs. 135.0 minutes; p < .010). No neuropathic pain was reported.

Conclusions Intercostal nerve cryoablation is a superior analgesic method compared with CEA, with reduced LOS, opioid use, and NRS pain scores. The prophylactic use of gabapentin is redundant.

Keywords

Nuss procedure - pectus excavatum - intercostal nerve cryoablation - continuous epidural analgesia

Ethical Approval

Given the nature of this research, not interfering with the treatment of patients, an official waiver of ethical approval (W20_235 # 20.271) was granted by the Medical Research Ethics Committee (METC) of the Amsterdam UMC, Amsterdam, the Netherlands (Chairperson MSc. O. Harlaar) on 28 May 2020. Informed consent was obtained from all individual patients (or their parents) included in this study.


* Both authors contributed equally to the study.




Publication History

Received: 06 November 2023

Accepted: 16 January 2024

Accepted Manuscript online:
19 January 2024

Article published online:
16 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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