Intraoperative cryoanalgesia for managing pain after the Nuss procedure.
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.


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.


METHODS
Treatment study: case series; Evidence level IV.
Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, Oakland and San Francisco, CA.
Claire
C
Graves
Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, Oakland and San Francisco, CA.
Olajire
O
Idowu
Department of Cardiothoracic Surgery, Regional Medical Center, San Jose, CA.
Sang
S
Lee
Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, Oakland and San Francisco, CA.
Benjamin
B
Padilla
Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, Oakland and San Francisco, CA. Electronic address: skim@mail.cho.org.
Sunghoon
S
Kim
D000293:Adolescent; D000328:Adult; D000698:Analgesia / Q000379:methods*; D002648:Child; D017679:Cryotherapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D007367:Intercostal Nerves; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D019637:Orthopedic Procedures; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D012189:Retrospective Studies; D013906:Thoracoscopy; D016896:Treatment Outcome; D055815:Young Adult
Cryoanalgesia; Cryoprobe; Epidural analgesia; Nuss procedure; Pectus excavatum