Clinical outcomes of intercostal cryoablation for Nuss procedure [Oral presentation]

Abstract

<p>Aim: Nuss procedure is a minimally invasive thoracoscopic repair for pectus excavatum. Poor pain control remains a hindrance for early discharge despite variable analgesic modalities including oral analgesics, patient-controlled analgesia and thoracic epidurals. This study aims to evaluate the clinical outcome of patients with intercostal nerve cryoablation for Nuss procedure. <br></p><p>Method: Medical records and medication dispensing logs of all patients undergoing Nuss procedure for pectus excavatum between 2016-2023 were reviewed retrospectively. Demographics, perioperative findings, analgesic regimens and complication rates were evaluated. Independent samples t-test was used to compare between groups with and without intracoastal nerve cryoablation. <br></p><p>Results: Forty-four patients with pectus excavatum underwent Nuss procedure at a median age of 14 years old from 2016-2023. Male to female ratio was 1:3.5. Cryoablation was performed in 21 (47.7%) patients. The median length of stay was 6 days (IQR 5-7) in non-cryoablation group vs 4 days (IQR 3-5) in cryoablation group (p=0.074). Use of oral paracetamol, non-steroid antiinflammatory drugs (NSAIDs) and opioids significantly reduced from 7 days (IQR 3.5-9) to 3 days (IQR 2-4), 5 days (IQR 4-7) to 2 days (IQR 2-3), and 5 days (IQR 4-7) to 3 days (2-3 days) respectively (p=0.003, p=0.011 and p=0.011). However, use of GABA-analogues remains similar (p=0.056). Neuropathic pain or local sensory disturbance were not noted in any of the patients in the cryoablation group. <br></p><p>Conclusion: Intercoastal cryoablation works as an effective analgesia for Nuss procedure which significantly reduces usage of paracetamol, NSAIDs and opioids, with minimal short term side effects seen.<br></p>