The incidence of neuropathic pain after intercostal cryoablation during the Nuss procedure

  • Michael J. Zobel
  • Clifton Ewbank
  • Roberta Mora
  • Olajire Idowu
  • Sunghoon Kim
  • Benjamin E. PadillaEmail author
Original Article



Intercostal nerve cryoblation during the Nuss procedure for pectus excavatum decreases pain, opiate requirement, and hospital length of stay (LOS) compared to thoracic epidural analgesia. However, long-term complications of cryoablation, including neuropathic pain development, are not well studied.


We conducted a multi-institutional retrospective review of patients following intercostal nerve cryoablation during Nuss bar insertion (11/2015–7/2018). Patients completed the Leeds Assessment of Neuropathic Symptoms and Signs, a validated questionnaire for detecting neuropathic symptoms. Primary outcome was neuropathic pain development. Secondary outcomes included duration of chest numbness and LOS. T test was performed; p < 0.05 is significant.


43 patients underwent intercostal cryoablation during the Nuss procedure. Ages at repair ranged 11–47 years (median 16). Patients were grouped by age: ≤ 21 years (30 patients) or older (13 patients). Mean LOS was shorter for the younger group, 2.0 versus 3.9 days (p = 0.03). No patients in the younger group, and three in the older, experienced neuropathic pain. Mean time to numbness resolution was shorter for the younger group, 3.4 versus 10.8 months (p = 0.003).


In pediatric patients, intercostal cryoablation provides effective analgesia following the Nuss procedure with minimal risk of post-operative neuropathic pain. Adult patients are at greater risk of experiencing neuropathic pain and prolonged numbness.


Pectus excavatum Nuss procedure Intercostal nerve cryoablation Neuropathic pain Thoracoscopic 



This study did not receive any funding.

Compliance with ethical standards

Conflict of interest

All of the authors (Zobel, Ewbank, Mora, Idowu, Kim, Padilla) declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Pediatric Surgery, Department of SurgeryUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Division of Pediatric Surgery, Department of SurgeryUCSF Benioff Children’s Hospital OaklandOaklandUSA

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