The incidence of neuropathic pain after intercostal cryoablation during the Nuss procedure
- 63 Downloads
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.
KeywordsPectus 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.
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 was obtained from all individual participants included in the study.
- 3.Takanari K, Toriyama K, Kambe M, Nakamura Y, Uchibori T, Ebisawa K, et al (2018) Nuss procedure for patients with pectus excavatum with a history of intrathoracic surgery. J Plast Reconstr Aesthet SurgGoogle Scholar
- 6.Kelly RE Jr, Shamberger RC, Mellins RB, Mitchell KK, Lawson ML, Oldham K et al (2007) Prospective multicenter study of surgical correction of pectus excavatum: design, perioperative complications, pain, and baseline pulmonary function facilitated by internet-based data collection. J Am Coll Surg 205(2):205–216CrossRefGoogle Scholar
- 8.Schlatter MG, Nguyen LV, Tecos M, Kalbfell EL, Gonzalez-Vega O, Vlahu T (2019) Progressive reduction of hospital length of stay following minimally invasive repair of pectus excavatum: a retrospective comparison of three analgesia modalities, the role of addressing patient anxiety, and reframing patient expectations. J Pediatr Surg 54(4):663–669CrossRefGoogle Scholar
- 11.Weber T, Matzl J, Rokitansky A, Klimscha W, Neumann K, Deusch E et al (2007) Superior postoperative pain relief with thoracic epidural analgesia versus intravenous patient-controlled analgesia after minimally invasive pectus excavatum repair. J Thorac Cardiovasc Surg 134(4):865–870CrossRefGoogle Scholar
- 19.Graves CE, Moyer J, Zobel MJ, Mora R, Smith D, O'Day M et al (2019) Intraoperative intercostal nerve cryoablation during the Nuss procedure reduces length of stay and opioid requirement: a randomized clinical trial. J Pediatr SurgGoogle Scholar
- 20.Keller BA, Kabagambe SK, Becker JC, Chen YJ, Goodman LF, Clark-Wronski JM et al (2016) Intercostal nerve cryoablation versus thoracic epidural catheters for postoperative analgesia following pectus excavatum repair: preliminary outcomes in twenty-six cryoablation patients. J Pediatr Surg 51(12):2033–2038CrossRefGoogle Scholar