Department of Thoracic Surgery, Zuyderland Medical Centre, Heerlen, Netherlands.
Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.
Interact Cardiovasc Thorac Surg. 2020 Oct 1;31(4):486-498. doi: 10.1093/icvts/ivaa151.
Minimally invasive pectus excavatum repair via the Nuss procedure is associated with significant postoperative pain that is considered as the dominant factor affecting the duration of hospitalization. Postoperative pain after the Nuss procedures is commonly controlled by thoracic epidural analgesia. Recently, intercostal nerve cryoablation has been proposed as an alternative method with long-acting pain control and shortened hospitalization. The subsequent objective was to systematically review the outcomes of intercostal nerve cryoablation in comparison to thoracic epidural after the Nuss procedure.
Six scientific databases were searched. Data concerning the length of hospital stay, operative time and postoperative opioid usage were extracted. If possible, data were submitted to meta-analysis using the mean of differences, random-effects model with inverse variance method and I2 test for heterogeneity.
Four observational and 1 randomized study were included, enrolling a total of 196 patients. Meta-analyses demonstrated a significantly shortened length of hospital stay [mean difference -2.91 days; 95% confidence interval (CI) -3.68 to -2.15; P < 0.001] and increased operative time (mean difference 40.91 min; 95% CI 14.42-67.40; P < 0.001) for cryoablation. Both analyses demonstrated significant heterogeneity (both I2 = 91%; P < 0.001). Qualitative analysis demonstrated the amount of postoperative opioid usage to be significantly lower for cryoablation in 3 out of 4 reporting studies.
Intercostal nerve cryoablation during the Nuss procedure may be an attractive alternative to thoracic epidural analgesia, resulting in shortened hospitalization. However, given the low quality and heterogeneity of studies, more randomized controlled trials are needed.
微创漏斗胸修复术（Nuss 手术）相关的术后疼痛明显，被认为是影响住院时间的主要因素。Nuss 手术后的疼痛通常通过胸段硬膜外镇痛来控制。最近，肋间神经冷冻消融术被提议作为一种替代方法，具有长效止痛和缩短住院时间的优点。随后的目的是系统地评估 Nuss 手术后肋间神经冷冻消融术与胸段硬膜外镇痛的结果。
检索了 6 个科学数据库。提取了有关住院时间、手术时间和术后阿片类药物使用的数据。如果可能，使用差值的平均值、随机效应模型和异质性检验（I2 检验）进行荟萃分析。
纳入了 4 项观察性研究和 1 项随机研究，共纳入 196 例患者。荟萃分析显示，冷冻消融术组的住院时间显著缩短[平均差值-2.91 天；95%置信区间（CI）-3.68 至-2.15；P<0.001]，手术时间增加[平均差值 40.91 分钟；95%CI 14.42 至 67.40；P<0.001]。这两项分析均显示出显著的异质性（均 I2=91%；P<0.001）。定性分析显示，在 4 项报告研究中有 3 项报告冷冻消融术组的术后阿片类药物使用量显著减少。
Nuss 手术期间行肋间神经冷冻消融术可能是胸段硬膜外镇痛的一种有吸引力的替代方法，可缩短住院时间。然而，鉴于研究质量低且存在异质性，需要更多的随机对照试验。
