Harbaugh Calista M, Johnson Kevin N, Kein Courtney E, Jarboe Marcus D, Hirschl Ronald B, Geiger James D, Gadepalli Samir K
Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Michigan.
J Surg Res. 2018 Nov;231:217-223. doi: 10.1016/j.jss.2018.05.048. Epub 2018 Jun 21.
This study aimed to evaluate postoperative outcomes after minimally invasive repair of pectus excavatum (Nuss procedure) using video-assisted intercostal nerve cryoablation (INC) compared to thoracic epidural (TE).
We performed a single center retrospective review of pediatric patients who underwent Nuss procedure with INC (n = 19) or TE (n = 13) from April 2015 to August 2017. Preoperative, intraoperative, and postoperative characteristics were collected. The primary outcome was length of stay (LOS) and secondary outcomes were intravenous and oral opioid use, pain scores, and complications. Opioids were converted to oral morphine milligram equivalents per kilogram (oral morphine equivalent [OME]/kg). Mann-Whitney U test was used for continuous and chi-squared analysis for categorical variables.
There were no significant differences in patient characteristics, except Haller Index (INC: median [interquartile range] 4.3 [3.6-4.9]; TE: 3.2 [2.8-4.0]; P = 0.03). LOS was shorter with INC (INC: 3 [3-4] days; TE: 6 [5-7] days; P < 0.001). Opioid use was higher intraoperatively (INC: 1.08 [0.87-1.37] OME/kg; TE: 0.46 [0.37-0.67] OME/kg; P = 0.002) and unchanged postoperatively (INC: 1.78 [1.26-3.77] OME/kg; TE: 1.82 [1.05-3.37] OME/kg; P = 0.80), and prescription doses were lower at discharge in INC (INC: 30 [30-40] doses; TE: 42 [40-60] doses; P = 0.005). There was no significant difference in postoperative complications (INC: 42.1%; TE: 53.9%; P = 0.51).
INC during Nuss procedure reduced LOS, shifting postoperative opioid use earlier during admission. This may reflect the need for improved early pain control until INC takes effect. Prospective evaluation after INC is needed to characterize long-term pain medication requirements.
本研究旨在评估与胸椎硬膜外麻醉（TE）相比，在漏斗胸微创修复术（Nuss手术）中使用电视辅助肋间神经冷冻消融术（INC）后的术后结果。
我们对2015年4月至2017年8月期间接受Nuss手术并采用INC（n = 19）或TE（n = 13）的儿科患者进行了单中心回顾性研究。收集术前、术中和术后特征。主要结局是住院时间（LOS），次要结局是静脉和口服阿片类药物使用情况、疼痛评分及并发症。阿片类药物转换为每千克口服吗啡毫克当量（口服吗啡当量[OME]/kg）。连续变量采用Mann-Whitney U检验，分类变量采用卡方分析。
除哈勒指数外，患者特征无显著差异（INC：中位数[四分位间距]4.3[3.6 - 4.9]；TE：3.2[2.8 - 4.0]；P = 0.03）。INC组的LOS更短（INC：3[3 - 4]天；TE：6[5 - 7]天；P < 0.001）。术中阿片类药物使用量更高（INC：1.08[0.87 - 1.37]OME/kg；TE：0.46[0.37 - 0.67]OME/kg；P = 0.002），术后无变化（INC：1.78[1.26 - 3.77]OME/kg；TE：1.82[1.05 - 3.37]OME/kg；P = 0.80），且INC组出院时的处方剂量更低（INC：3
