Intercostal Cryoablation: a Novel Method of Pain Management for the Nuss Procedure

From the APSA 2016 Annual Meeting proceedings

INTERCOSTAL CRYOABLATION: A NOVEL METHOD OF PAIN MANAGEMENT FOR THE NUSS PROCEDURE
Y. Julia Chen, MD, Benjamin Keller, MD, Jacob Stephenson, MD, Amy Rahm, MD,
Rebecca Stark, MD, Shinjiro Hirose, MD, Gary Raff, MD.
University of California, Davis Medical Center, Sacramento, CA, USA.

Purpose:
Achieving adequate analgesia in patients undergoing the Nuss Procedure for pectus excavatum is a significant determinant of postoperative recovery. Pain management strategies have evolved throughout the last decade, however there is no consensus on the optimal regimen. Practice varies according to institution and surgeon. Intercostal cyroanalgesia has been described in the literature for long-term management of post thoracotomy pain syndrome and has been established as safe and feasible in the adult population. The aim of this video is to introduce the usage of intercostal cryoablation as a novel method of pain control in children undergoing the Nuss Procedure for pectus excavatum.

Methods/Results:
We demonstrate operative footage and describe the technique of intraoperative intercostal nerve ablation during the Nuss Procedure. Using the cyroanalgesia probe T3-T6 are ablated bilaterally under direct visualization with the thoracoscope prior to
insertion of the Nuss bar. This provides immediate and durable postoperative analgesia. Using this method, the need for thoracic epidural has been eliminated from our practice and patients are fast-tracked with decreased length of stay. There have been no complications reported related to cryoablation in the 6 months that we have used this technique.

Conclusions:
Intraoperative bilateral intercostal cryoablation is a safe and feasible method of pain control in children with pectus excavatum undergoing the Nuss Procedure.

DOI:https://doi.org/10.17797/9s1mvk79sn