Claire Graves1, Olajire Idowu1, Sang Lee2, Benjamin Padilla1, Sunghoon Kim3. 1. Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, Oakland and San Francisco, CA. 2. Department of Cardiothoracic Surgery, Regional Medical Center, San Jose, CA. 3. Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, Oakland and San Francisco, CA. Electronic address: skim@mail.cho.org.
Abstract
BACKGROUND: Cryoanalgesia prevents pain by freezing the affected peripheral nerve. We report the use of intraoperative cryoanalgesia during the Nuss procedure for pectus excavatum and describe our initial experience, modifications of technique, and lessons learned. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who received cryoanalgesia during the Nuss procedure between June 1, 2015, and April 30, 2016, at our institutions and analyzed modifications in surgical technique during this early adoption period. RESULTS: Eight male and two female patients underwent the Nuss procedure with cryoanalgesia. The mean postoperative length of stay (LOS) was 2days (range 1-3). Average inpatient pain scores were 3.4, 3.2, and 4.6 on postoperative days 1-3, respectively (N=10, 7, and 2). At a 1-week postoperative visit, mean pain score was 1.1 (N=6). Compared to the preceding 15 Nuss patients at our institution, who were treated with a thoracic epidural, postoperative LOS was significantly shorter with cryoanalgesia (2.0±0.82 vs. 6.3±1.3days, P<0.001). We modified our technique for patient habitus and adopted single-lung ventilation for improved visualization. CONCLUSIONS: Cryoanalgesia may be the ideal pain management strategy for Nuss patients because it is effective and long lasting. Intraoperative application is easily integrated into the Nuss procedure. STUDY TYPE: Treatment study: case series; Evidence level IV.
BACKGROUND: Cryoanalgesia prevents pain by freezing the affected peripheral nerve. We report the use of intraoperative cryoanalgesia during the Nuss procedure for pectus excavatum and describe our initial experience, modifications of technique, and lessons learned. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who received cryoanalgesia during the Nuss procedure between June 1, 2015, and April 30, 2016, at our institutions and analyzed modifications in surgical technique during this early adoption period. RESULTS: Eight male and two female patients underwent the Nuss procedure with cryoanalgesia. The mean postoperative length of stay (LOS) was 2days (range 1-3). Average inpatient pain scores were 3.4, 3.2, and 4.6 on postoperative days 1-3, respectively (N=10, 7, and 2). At a 1-week postoperative visit, mean pain score was 1.1 (N=6). Compared to the preceding 15 Nuss patients at our institution, who were treated with a thoracic epidural, postoperative LOS was significantly shorter with cryoanalgesia (2.0±0.82 vs. 6.3±1.3days, P<0.001). We modified our technique for patienthabitus and adopted single-lung ventilation for improved visualization. CONCLUSIONS: Cryoanalgesia may be the ideal pain management strategy for Nuss patients because it is effective and long lasting. Intraoperative application is easily integrated into the Nuss procedure. STUDY TYPE: Treatment study: case series; Evidence level IV.
Authors: Davina Wildemeersch; Michiel D'Hondt; Lisa Bernaerts; Pieter Mertens; Vera Saldien; Jeroen Mh Hendriks; Anne-Sophie Walcarius; Lutgard Sterkens; Guy H Hans Journal: JMIR Perioper Med Date: 2018-10-12