Abstract
Purpose
Intercostal nerve cryoblation during the Nuss procedure for pectus excavatum decreases pain, opiate requirement, and hospital length of stay (LOS) compared to thoracic epidural analgesia. However, long-term complications of cryoablation, including neuropathic pain development, are not well studied.
Methods
We conducted a multi-institutional retrospective review of patients following intercostal nerve cryoablation during Nuss bar insertion (11/2015–7/2018). Patients completed the Leeds Assessment of Neuropathic Symptoms and Signs, a validated questionnaire for detecting neuropathic symptoms. Primary outcome was neuropathic pain development. Secondary outcomes included duration of chest numbness and LOS. T test was performed; p < 0.05 is significant.
Results
43 patients underwent intercostal cryoablation during the Nuss procedure. Ages at repair ranged 11–47 years (median 16). Patients were grouped by age: ≤ 21 years (30 patients) or older (13 patients). Mean LOS was shorter for the younger group, 2.0 versus 3.9 days (p = 0.03). No patients in the younger group, and three in the older, experienced neuropathic pain. Mean time to numbness resolution was shorter for the younger group, 3.4 versus 10.8 months (p = 0.003).
Conclusion
In pediatric patients, intercostal cryoablation provides effective analgesia following the Nuss procedure with minimal risk of post-operative neuropathic pain. Adult patients are at greater risk of experiencing neuropathic pain and prolonged numbness.
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All of the authors (Zobel, Ewbank, Mora, Idowu, Kim, Padilla) declare that they have no conflicts of interest.
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Zobel, M.J., Ewbank, C., Mora, R. et al. The incidence of neuropathic pain after intercostal cryoablation during the Nuss procedure. Pediatr Surg Int 36, 317–324 (2020). https://doi.org/10.1007/s00383-019-04602-1
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DOI: https://doi.org/10.1007/s00383-019-04602-1