Intercostal nerve cryoablation therapy for the repair of pectus excavatum: a systematic review

Abstract

IntroductionThe minimally invasive repair of pectus excavatum (PE) is a painful procedure that can result in long-term hospitalization and opioid use. To mitigate the length of stay and opioid consumption, many different analgesia strategies have been implemented. The aim of this study is to review the use and patient outcomes of intercostal nerve cryoablation (INC) during PE repair reported in the literature.MethodsAn unfunded literature search using PubMed identifying articles discussing INC during PE repair from 1946 to 1 July 2023 was performed. Articles were included if they discussed patient outcomes with INC use during PE repair. Articles were excluded if they were reviews/meta-analyses, editorials, or not available in English. Each article was reviewed for bias by analyzing the study methods, data analysis, patient selection, and patient follow-up. Articles comparing outcomes of INC were considered significant if p-value was <0.05.ResultsA total of 34 articles were included in this review that described INC use during pectus repair. Most supported a decreased hospital length of stay and opioid use with INC. Overall, INC was associated with fewer short-term and long-term complications. However, the researchers reported varied results of total hospital costs with the use of INC.ConclusionThe review was limited by a paucity of prospective studies and low number of patients who received INC. Despite this, the present data support INC as a safe and effective analgesic strategy during the repair of PE.

Effect of Cryoablation in Nuss Bar Placement on Opioid Utilization and Length of Stay

“…This nding was supported by the literature review by Eldredge et al, which found that the overall complication rate was either signi cantly lower or no difference between the INC and non-INC cohorts. 4 While our study reported a slightly higher complication rate compared to other studies, we have implemented several practices to reduce this rate, including a comprehensive infection prevention protocol. Notably, all brachial plexus injuries in the INC group have fully recovered.…”

“…1,2 PE results in an inward depression of the sternum and may lead to a decrease in cardiopulmonary tness and result in psychosocial distress. [3][4][5] Surgical correction of PE is commonly carried out via the Nuss procedure or the minimally invasive repair of pectus excavatum (MIRPE). [6][7][8] During MIRPE, a concave metal bar is placed behind the sternum and rotated into place resulting in an immediate remodeling of the chest wall resulting in signi cant postoperative pain.…”

“…This makes it di cult to assess whether patients are actually needing fewer opioids, or if they are just leaving the hospital sooner. 4 Additionally, only half of the studies reviewed by Eldredge et al reported the complications associated with cryoablation, and most studies contained fewer than 60 patients who had undergone cryoablation. Given the increasingly widespread use of cryoablation, more extensive research is needed to examine the in uence of INC on MIRPE.…”