Outcomes Using Cryoablation for Postoperative Pain Control in Children Following Minimally Invasive Pectus Excavatum Repair

Sujka, Joseph; Benedict, Leo Andrew; Fraser, Jason D.; Aguayo, Pablo; Millspaugh, Daniel L.; Peter, Shawn D. St.

doi:10.1089/lap.2018.0111

Cited by 39 publications

(30 citation statements)

References 11 publications

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“…Cryoanalgesia creates wallerian degeneration without interrupting the myelin sheath and endoneurium, so we prefer the term of "cryoanalgesia" to the term "cryoablation" often reported in the literature and suggesting the (wrong) idea of removing something. Cryoanalgesia proved to be useful in terms of reduction of opioid consumption and hospital stay in previous experiences in North and South America [US (9)(10)(11)(12) and Argentina (13)]. Our experience is consistent with the other reported experiences, even if the protocols adopted and the cryogenic systems used are different from place to place.…”

Section: Discussionsupporting

confidence: 89%

“…According to the recent literature on cryoanalgesia in MIRPE, published from North and South America, cryoanalgesia has the potentiality to reduce analgesic consumption and length of hospitalization, but also to ameliorate persistent pain and facilitate return to normal activity (8)(9)(10)(11)(12)(13). However, the technique of cryoanalgesia was not homogeneous: in the reports available so far, different protocols, probes and different cryogenics systems were used, manufactured by US Companies (©AtriCure, Inc., Mason OH; Frigitronics R , Connecticut).…”

Section: Introductionmentioning

confidence: 99%

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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: 89%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…In 2018, Sujka et al 8 conducted a retrospective study evaluating 28 patients undergoing pectus excavatum repair, nine of whom underwent cryoneurolysis and the remaining 19 using a combination of epidural and/or PCA. In the cryoneurolysis group, hospital length of stay (1.4 vs. 4.0 days, p=0.00), days to only oral pain medications (1.2 vs. 2.6 days, p=0.00), and postoperative day 2 pain scores (3.3 vs. 6.1, p=0.03) were less.…”

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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“…In our early experience with 9 patients who underwent cryoablation during minimally invasive pectus excavatum repair, days to only oral pain medication (1.22 vs. 2.63 days) and length of stay (1.4 vs. 4 days) were significantly shorter in the cryoablation group compared with patients who had either PCA or epidural for postoperative pain control. 23 Other retrospective reviews of early results from this method of analgesia have been promising, and further investigation is needed to determine if there are any long-term neurological complications associated with this technique. [24][25][26] Though this technique is gaining in popularity, currently the two most common methods of postoperative pain control in minimally invasive pectus excavatum repair are epidural and PCA.…”

Section: Discussionmentioning

confidence: 99%

Epidural versus PCA Pain Management after Pectus Excavatum Repair: A Multi-Institutional Prospective Randomized Trial

et al. 2019

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Introduction Postoperative pain control remains the primary reason for inpatient stay after minimally invasive repair of pectus excavatum. In a previous study, our group reported that early pain control was better in patients managed with a thoracic epidural, while late pain control was better in patients managed with patient-controlled analgesia (PCA). After revising our epidural transition and modifying the PCA protocol, we conducted a multi-institutional prospective randomized trial to evaluate these two pain control strategies. Materials and Methods Patients were randomized to epidural or PCA following minimally invasive repair of pectus excavatum with standard protocols for each arm. Primary outcome was length of stay with secondary variables including mean patient pain scores, complications, and parental satisfaction. Scores were pooled for the two groups and reported as means with standard deviation. Results were compared using t-tests and one-way analysis of variance with p-value < 0.05 determining significance. Results Sixty-five patients were enrolled, 32 epidural and 33 PCA. Enrollment was stopped early when we developed an alternative strategy for controlling these patients' pain. There was no difference in length of stay in hours between the two arms; epidural 111.3 ± 18.5 versus PCA 111.4 ± 51.4, p = 0.98. Longer operative time was found in the epidural group. Nine patients in the epidural group (28%) required a PCA in addition to epidural for adequate pain control. Mean pain scores were lower on postoperative day 0 in the epidural group compared with the PCA groups, but were otherwise similar. Conclusion In our prospective randomized trial, PCA is just as effective as thoracic epidural in decreasing early postoperative pain scores after minimally invasive repair of pectus excavatum.

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Outcomes Using Cryoablation for Postoperative Pain Control in Children Following Minimally Invasive Pectus Excavatum Repair

Abstract: Cryoablation after pectus bar placement dramatically decreases narcotic usage and postoperative length of stay.

Cited by 39 publications

References 11 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

Epidural versus PCA Pain Management after Pectus Excavatum Repair: A Multi-Institutional Prospective Randomized Trial

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