title: Intercostal nerve cryoablation versus thoracic epidural catheters for postoperative analgesia following pectus excavatum repair: Preliminary outcomes in twenty-six cryoablation patients.
abstract: BACKGROUND
  Multimodal pain management strategies are used for analgesia following pectus excavatum repair. However, the optimal regimen has not been identified. We describe our early experience with intercostal cryoablation for pain management in children undergoing the Nuss procedure and compare early cryoablation outcomes to our prior outcomes using thoracic epidural analgesia.
  
  
  METHODS
  A multi-institutional, retrospective review of fifty-two patients undergoing Nuss bar placement with either intercostal cryoablation (n=26) or thoracic epidural analgesia (n=26) from March 2013 to January 2016 was conducted. The primary outcome was hospital length of stay. Secondary outcomes included telemetry unit monitoring time, total intravenous narcotic use, duration of intravenous narcotic use, and postoperative complications.
  
  
  RESULTS
  Patients who underwent intercostal cryoablation had a significant reduction in the mean hospital length of stay, time in a monitored telemetry bed, total use of intravenous narcotics, and the duration of intravenous narcotic administration when compared to thoracic epidural patients. Cryoablation patients had a slightly higher rate of postoperative complications.
  
  
  CONCLUSIONS
  Intercostal cryoablation is a promising technique for postoperative pain management in children undergoing repair of pectus excavatum. This therapy results in reduced time to hospital discharge, decreased intravenous narcotic utilization, and has eliminated epidurals from our practice.
  
  
  METHODS
  Retrospective study - level III.
authors.affiliation: Davis Health System, Department of Surgery, University of California, Sacramento, CA. Electronic address: bakeller@ucdavis.edu.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Keller
authors.affiliation: Davis Health System, Department of Surgery, University of California, Sacramento, CA.
authors.forename: Sandra K
authors.initials: SK
authors.lastname: Kabagambe
authors.affiliation: Davis Health System, Department of Surgery, University of California, Sacramento, CA.
authors.forename: James C
authors.initials: JC
authors.lastname: Becker
authors.affiliation: Davis Health System, Department of Surgery, University of California, Sacramento, CA.
authors.forename: Y Julia
authors.initials: YJ
authors.lastname: Chen
authors.affiliation: Davis Health System, Department of Surgery, University of California, Sacramento, CA.
authors.forename: Laura F
authors.initials: LF
authors.lastname: Goodman
authors.affiliation: Davis Health System, Department of Anesthesia, University of California, Sacramento, CA.
authors.forename: Julianna M
authors.initials: JM
authors.lastname: Clark-Wronski
authors.affiliation: Davis Health System, Department of Anesthesia, University of California, Sacramento, CA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Furukawa
authors.affiliation: Davis Health System, Department of Surgery, University of California, Sacramento, CA; Department of Surgery, Shriners Hospital for Children - Northern California, Sacramento, CA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Stark
authors.affiliation: Davis Health System, Department of Surgery, University of California, Sacramento, CA; Department of Surgery, Shriners Hospital for Children - Northern California, Sacramento, CA.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Rahm
authors.affiliation: Davis Health System, Department of Surgery, University of California, Sacramento, CA; Department of Surgery, Shriners Hospital for Children - Northern California, Sacramento, CA.
authors.forename: Shinjiro
authors.initials: S
authors.lastname: Hirose
authors.affiliation: Davis Health System, Department of Surgery, University of California, Sacramento, CA; Department of Surgery, Shriners Hospital for Children - Northern California, Sacramento, CA.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Raff
mesh_terms: D000293:Adolescent; D015360:Analgesia, Epidural / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D007367:Intercostal Nerves / Q000601:surgery*; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy / Q000601:surgery*; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid
keywords: Cryoablation; Epidural analgesia; Nuss procedure; Pain management; Pectus excavatum