Cryoanalgesia in Patients Undergoing Nuss Repair of Pectus Excavatum: Technique Modification and Early Results

Morikawa, Nicole; Laferriere, Nicole R; Koo, Sylvia; Johnson, Sidney M.; Woo, Russell; Puapong, Devin P.

doi:10.1089/lap.2017.0665

Cited by 46 publications

(33 citation statements)

References 23 publications

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“…Parrado et al (16) compared post-operative consumption of morphine in three different groups (cryoanalgesia, epidural, and multimodal analgesia) and they found that opioid consumption was lower in cryoanalgesia group (237 mg). In our pilot study the average value of total opioid consumption was 7.5 mg in line with results of Morikawa et al (17). Our patients showed a length of stay of 2.4 days, in line with other studies [1.9 days in Grave et al's (11), 2.2 ± 0.4 in Morikawa et al's (17)].…”

Section: Discussionsupporting

confidence: 92%

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

et al. 2021

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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.

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Section: Discussionsupporting

confidence: 92%

“…In our pilot study the average value of total opioid consumption was 7.5 mg in line with results of Morikawa et al (17). Our patients showed a length of stay of 2.4 days, in line with other studies [1.9 days in Grave et al's (11), 2.2 ± 0.4 in Morikawa et al's (17)].…”

Section: Discussionsupporting

confidence: 92%

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

et al. 2021

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“…Five subgroups of patients were identified: pectus excavatum (nine studies); thoracotomy (eight studies); post-thoracotomy pain syndrome (PTPS; three studies); chest wall pain from malignancy (two studies); and traumatic rib fractures (two studies). In 2018, Morikawa et al 7 performed a retrospective review comparing children who received cryoneurolysis (n=6) during Nuss repair to those who did not (n=13). Patients who underwent cryoneurolysis were discharged faster (2.2 vs. 3.7 days, p=0.01) and required lower narcotic doses (6.4 vs. 17.9 morphine equivalents (ME), p=0.05).…”

Section: Resultsmentioning

confidence: 99%

Efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain after surgery or trauma: systematic review

Péter

Min

Patil

et al. 2021

Trauma Surg Acute Care Open

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BackgroundThere is a critical need for non-narcotic analgesic adjuncts in the treatment of thoracic pain. We evaluated the efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain, specifically addressing the applicability of intercostal cryoneurolysis for pain control after chest wall trauma.MethodsA systematic review was performed through searches of PubMed, EMBASE, and the Cochrane Library. We included studies involving patients of all ages that evaluated the efficacy of intercostal cryoneurolysis as a pain adjunct for chest wall pathology. Quantitative and qualitative synthesis was performed.ResultsTwenty-three studies including 570 patients undergoing cryoneurolysis met eligibility criteria for quantitative analysis. Five subgroups of patients treated with intercostal cryoneurolysis were identified: pectus excavatum (nine studies); thoracotomy (eight studies); post-thoracotomy pain syndrome (three studies); malignant chest wall pain (two studies); and traumatic rib fractures (one study). There is overall low-quality evidence supporting intercostal cryoneurolysis as an analgesic adjunct for chest wall pain. A majority of studies demonstrated decreased inpatient narcotic use with intercostal cryoneurolysis compared with conventional pain modalities. Intercostal cryoneurolysis may also lead to decreased hospital length of stay. The procedure did not definitively increase operative time, and risk of complications was low.ConclusionsGiven the favorable risk-to-benefit profile, both percutaneous and thoracoscopic intercostal cryoneurolysis may serve as a worthwhile analgesic adjunct in trauma patients with rib fractures who have failed conventional medical management. However, further prospective studies are needed to improve quality of evidence.Level of evidenceLevel IV systematic reviews and meta-analyses.

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“…There were no differences in self-reported pain scores for the first 3 days post-operatively, but there was some neuropathic pain in the cryoanalgesia group in the months that followed. Morikawa et al [524] examined the use of intercostal nerve cryoanalgesia (n = 6 patients) supplementing the use of standard pharmacological pain relief post-thoracotomy (n = 13 patients with no cryoanalgesia). Pain scores were not different, but the patients supplemented with intercostal nerve cryoanalgesia had a lower opioid requirement and were discharged on average 1 day earlier.…”

Section: Cryoanalgesiamentioning

confidence: 99%

Analgesia for Sheep in Commercial Production: Where to Next?

Small

Fisher

et al. 2021

Animals

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Increasing societal and customer pressure to provide animals with ‘a life worth living’ continues to apply pressure on livestock production industries to alleviate pain associated with husbandry practices, injury and illness. Over the past 15–20 years, there has been considerable research effort to understand and develop mitigation strategies for painful husbandry procedures in sheep, leading to the successful launch of analgesic approaches specific to sheep in a number of countries. However, even with multi-modal approaches to analgesia, using both local anaesthetic and non-steroidal anti-inflammatory drugs (NSAID), pain is not obliterated, and the challenge of pain mitigation and phasing out of painful husbandry practices remains. It is timely to review and reflect on progress to date in order to strategically focus on the most important challenges, and the avenues which offer the greatest potential to be incorporated into industry practice in a process of continuous improvement. A structured, systematic literature search was carried out, incorporating peer-reviewed scientific literature in the period 2000–2019. An enormous volume of research is underway, testament to the fact that we have not solved the pain and analgesia challenge for any species, including our own. This review has highlighted a number of potential areas for further research.

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Cryoanalgesia in Patients Undergoing Nuss Repair of Pectus Excavatum: Technique Modification and Early Results

Abstract: Our technique modification simplifies previously described approaches to intercostal nerve cryoablation. Patients undergoing this adjunct benefit with less PNR and a faster discharge time.

Cited by 46 publications

References 23 publications

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

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

Efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain after surgery or trauma: systematic review

Analgesia for Sheep in Commercial Production: Where to Next?

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