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Purpose <p>Minimally invasive pectus excavatum repair (MIRPE) using the Nuss procedure is associated with significant postoperative pain. Intercostal nerve cryoablation (INC), used alone or with adjuncts like intercostal nerve blocks (INB) have improved pain control. This retrospective study aimed to compare the impact of INC with INB on overall postoperative medication exposure.</p> Methods <p>Patients aged ≤ 20 years who underwent MIRPE with bilateral INC and INB (INC-INB) from 2021 - March 2023 were compared to historical controls with bilateral paravertebral blocks (PVB) from 2018 to 2020. Demographics, operative details, and outcomes were compared using Chi-square and Kruskal-Wallis tests.</p> Results <p>Of 164 patients, 90 (55%) underwent repair with INC-INB, and 74 (45%) with PVB. Age, Haller index, and second bar usage were comparable between groups. While median (IQR) operative time was longer for patients with INC-INB [110 (102, 122) vs. 69 (60, 82) minutes, <i>p</i> &lt; .001], total operating room time was equivalent [185 (169, 199) vs. 194 (174, 209) minutes, <i>p</i> = .09]. Compared to PVB, INC-INB was associated with lower opioid consumption [0 (0, 0.2) vs. 1.6 (0.7, 3.0) OME/kg, <i>p</i> &lt; .001], fewer total postoperative medications [6 (4, 7) vs. 12 (11, 13), <i>p</i> &lt; .001], and shorter length of stay [30 (28, 34) vs. 59 (55, 77) hours, <i>p</i> &lt; .001].</p> Conclusion <p>INC-INB reduces overall postoperative medication exposure and length of stay compared to percutaneous PVB for pain control in children undergoing MIRPE.</p> Level of evidence <p>III.</p>

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Intercostal nerve cryoablation with nerve blocks reduces postoperative medication use after minimally invasive pediatric pectus excavatum repair

  • 期刊论文

  • 发表日期：

    2026年2月9日

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  • Matthew T. Parrish,
  • Swathi R. Raikot,
  • Amy Glasgow,
  • D. Dean Potter Jr,
  • Denise B. Klinkner,
  • Stephanie F. Polites

摘要

Purpose

Minimally invasive pectus excavatum repair (MIRPE) using the Nuss procedure is associated with significant postoperative pain. Intercostal nerve cryoablation (INC), used alone or with adjuncts like intercostal nerve blocks (INB) have improved pain control. This retrospective study aimed to compare the impact of INC with INB on overall postoperative medication exposure.

Methods

Patients aged ≤ 20 years who underwent MIRPE with bilateral INC and INB (INC-INB) from 2021 - March 2023 were compared to historical controls with bilateral paravertebral blocks (PVB) from 2018 to 2020. Demographics, operative details, and outcomes were compared using Chi-square and Kruskal-Wallis tests.

Results

Of 164 patients, 90 (55%) underwent repair with INC-INB, and 74 (45%) with PVB. Age, Haller index, and second bar usage were comparable between groups. While median (IQR) operative time was longer for patients with INC-INB [110 (102, 122) vs. 69 (60, 82) minutes, p < .001], total operating room time was equivalent [185 (169, 199) vs. 194 (174, 209) minutes, p = .09]. Compared to PVB, INC-INB was associated with lower opioid consumption [0 (0, 0.2) vs. 1.6 (0.7, 3.0) OME/kg, p < .001], fewer total postoperative medications [6 (4, 7) vs. 12 (11, 13), p < .001], and shorter length of stay [30 (28, 34) vs. 59 (55, 77) hours, p < .001].

Conclusion

INC-INB reduces overall postoperative medication exposure and length of stay compared to percutaneous PVB for pain control in children undergoing MIRPE.

Level of evidence

III.