Intercostal nerve cryoablation versus thoracic epidural for postoperative analgesia following pectus excavatum repair: a systematic review and meta-analysis

Abstract

OBJECTIVES Minimally invasive pectus excavatum repair via the Nuss procedure is associated with significant postoperative pain that is considered as the dominant factor affecting the duration of hospitalization. Postoperative pain after the Nuss procedures is commonly controlled by thoracic epidural analgesia. Recently, intercostal nerve cryoablation has been proposed as an alternative method with long-acting pain control and shortened hospitalization. The subsequent objective was to systematically review the outcomes of intercostal nerve cryoablation in comparison to thoracic epidural after the Nuss procedure. METHODS Six scientific databases were searched. Data concerning the length of hospital stay, operative time and postoperative opioid usage were extracted. If possible, data were submitted to meta-analysis using the mean of differences, random-effects model with inverse variance method and I2 test for heterogeneity. RESULTS Four observational and 1 randomized study were included, enrolling a total of 196 patients. Meta-analyses demonstrated a significantly shortened length of hospital stay [mean difference −2.91 days; 95% confidence interval (CI) −3.68 to −2.15; P < 0.001] and increased operative time (mean difference 40.91 min; 95% CI 14.42–67.40; P < 0.001) for cryoablation. Both analyses demonstrated significant heterogeneity (both I2 = 91%; P < 0.001). Qualitative analysis demonstrated the amount of postoperative opioid usage to be significantly lower for cryoablation in 3 out of 4 reporting studies. CONCLUSIONS Intercostal nerve cryoablation during the Nuss procedure may be an attractive alternative to thoracic epidural analgesia, resulting in shortened hospitalization. However, given the low quality and heterogeneity of studies, more randomized controlled trials are needed.

Intercostal Nerve Cryoablation or Epidural Analgesia for Multimodal Pain Management after the Nuss Procedure: A Cohort Study

“…The LOS was three days shorter in the cryoablation group, which is similar to the literature (LOS varying from -2 to -3 days) [3][4][5]8 .…”

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

“…In view of the reports in the literature about the possibility of using cryolysis both during surgery and percutaneously—before the procedure, the question arises which of the methods brings more benefits ( 21 – 25 , 27 – 29 ). The intraoperative technique performed by the operator during thoracoscopy has undoubted advantages of direct contact and visual inspection.…”

New Aspects of Lung Transplantation: A Narrative Overview Covering Important Aspects of Perioperative Management

“…However, cryoablation of the intercostal nerve may be an attractive alternative to thoracic epidural analgesia [ 86 ]. Its prolonged analgesic effect, up to 3 to 9 months postoperatively, must be weighed against the risk of direct nerve injury (neuropathic pain and loss of intercostal muscle strength) [ 87 ].…”