A New Device for Thoracoscopic Cryoanalgesia in Pectus Excavatum Repair: Preliminary Single Center Experience

Abstract

Introduction: Cryoanalgesia has been recently described as alternative technique for immediate and persistent pain treatment after pectus excavatum repair. Cryoanalgesia has the potentiality to reduce analgesic consumption and length of hospitalization. However, cryoanalgesia has not been standardized yet: the previous reports describe different techniques and systems and include only small series. In Europe, no reports on cryoanalgesia for pectus repair have been published so far.Materials and Methods: This is a prospective single center pilot study performed in adolescents undergoing minimally invasive pectus excavatum repair with a new cryoanalgesia system, using a probe designed specifically for thoracoscopy. This new double lumen probe has the theoretical advantage of freezing only in its tip, so reducing the risk of complications.Results: Seven patients undergoing pectus excavatum repair were treated with cryoanalgesia performed with the new probe. No complications of cryoanalgesia were reported. Total consumption of morphine during hospital stay was between 0.1 and 0.35 mg/kg, with no side effects reported. Mean time to discharge was 2.4 days. All patients reported a good pain control with a fair need of rescue medications for pain relief during the first week after discharge, and a very good pain control without need of rescue medications during following weeks.Conclusions: Our pilot study showed that the new cryoanalgesia device is efficacious in terms of pain control, hospital stay and resumption of post-operative activities. The cryoprobe designed allowed an easy and safe maneuver. A prospective trial is needed to better define the risks and benefits of this technique.

Percutaneous Cryoanalgesia: A New Strategy for Pain Management in Pectus Excavatum Surgery

“…Although in most series a very small percentage of these are reported, Parrado et al reported that 9% of postoperative pneumothoraces in their study required a drainage tube or Sun et al reported a higher percentage of bar displacement in patients treated with PCr. 11,25 Different improvements have been designed to avoid this, such as the Parrado protective sheath, the use of a chest tube covering the cryoprobe described by Morikawa et al, or the use of a new cryoprobe reported by Torre et al 2,11,26 In our center, we eliminated the thoracoscopic approach and used the percutaneous approach with needle protecting the tissues with an angiocatheter so as not to damage them by contact and avoiding the risk of injury by contact of the cold with the lung, great vessels, or mediastinum by not entering the thoracic cavity. Our series reports no major intraoperative or postoperative complications during the cryoanalgesia process.…”

Intercostal nerve cryoanalgesia in the treatment of pain in patients operated on by the modified Nuss method with the BackOnFeet application—a new strategy to improve outcomes

“…This type of probe was first time used for children in Poland. Previous type of straight probe was used in Italy, Spain, Argentina ( 16 ). The technical modification of the probe facilitates positioning.…”

Ultrasound-Guided Percutaneous Cryoanalgesia for Pectus Excavatum: When Should It be Applied?

“…8 Several studies based on the application of thoracoscopic cryoanalgesia in MIRPE conclude a shorter hospital stay, reduced opioid consumption, and less pain compared with conventional techniques. 3,[9][10][11][12][17][18][19][20] As already described in the literature, the effect of cryoanalgesia can vary between 6 and 48 hours after application. In 2021, we conducted a study comparing patients in whom PCr was applied on the same day of PE surgery and those in whom it was applied 48 hours before surgery.…”

“…Numerous publications have demonstrated a lower degree of pain, lower opioid consumption, and shorter hospital stay. [8][9][10][11][12] The novel and recent ultrasound-guided percutaneous approach is an efficient, safe, and reproducible procedure. It has advantages over the thoracoscopic approach by avoiding possible lesions due to thermal contact of the cryoprobe, less dissection, less thoracoscopy time, and in case of having to repeat the technique due to failure of the first application, the approach is less complicated.…”