McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX.
Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX.
Ann Surg. 2023 Jun 1;277(6):e1373-e1379. doi: 10.1097/SLA.0000000000005440. Epub 2022 Jul 6.
To assess the clinical implications of cryoanalgesia for pain management in children undergoing minimally invasive repair of pectus excavatum (MIRPE).
MIRPE entails significant pain management challenges, often requiring high postoperative opioid use. Cryoanalgesia, which blocks pain signals by temporarily ablating intercostal nerves, has been recently utilized as an analgesic adjunct. We hypothesized that the use of cryoanalgesia during MIRPE would decrease postoperative opioid use and length of stay (LOS).
A multicenter retrospective cohort study of 20 US children's hospitals was conducted of children (age below 18 years) undergoing MIRPE from January 1, 2014, to August 1, 2019. Differences in total postoperative, inpatient, oral morphine equivalents per kilogram, and 30-day LOS between patients who received cryoanalgesia versus those who did not were assessed using bivariate and multivariable analysis. P value <0.05 is considered significant.
Of 898 patients, 136 (15%) received cryoanalgesia. Groups were similar by age, sex, body mass index, comorbidities, and Haller index. Receipt of cryoanalgesia was associated with lower oral morphine equivalents per kilogram (risk ratio=0.43, 95% confidence interval: 0.33-0.57) and a shorter LOS (risk ratio=0.66, 95% confidence interval: 0.50-0.87). Complications were similar between groups (29.8% vs 22.1, P =0.07), including a similar rate of emergency department visit, readmission, and/or reoperation.
Use of cryoanalgesia during MIRPE appears to be effective in lowering postoperative opioid requirements and LOS without increasing complication rates. With the exception of preoperative gabapentin, other adjuncts appear to increase and/or be ineffective at reducing opioid utilization. Cryoanalgesia should be considered for patients undergoing this surgery.
评估微创漏斗胸矫正术（MIRPE）中冷冻镇痛在儿童疼痛管理中的临床意义。
MIRPE 术后疼痛管理极具挑战性，通常需要大量使用术后阿片类药物。冷冻镇痛通过暂时消融肋间神经来阻断疼痛信号，最近已被用作辅助镇痛手段。我们假设在 MIRPE 中使用冷冻镇痛会减少术后阿片类药物的使用和住院时间（LOS）。
对 2014 年 1 月 1 日至 2019 年 8 月 1 日期间，在美国 20 家儿童医院进行的一项多中心回顾性队列研究，纳入年龄在 18 岁以下接受 MIRPE 的儿童。使用 bivariate 和 multivariable 分析评估接受冷冻镇痛和未接受冷冻镇痛的患者之间术后总时间、住院时间、每公斤口服吗啡等效物和 30 天 LOS 的差异。P 值<0.05 为差异有统计学意义。
在 898 名患者中，有 136 名（15%）接受了冷冻镇痛。两组在年龄、性别、体重指数、合并症和 Haller 指数方面相似。接受冷冻镇痛与较低的每公斤口服吗啡等效物（风险比=0.43，95%置信区间：0.33-0.57）和较短的 LOS（风险比=0.66，95%置信区间：0.50-0.87）相关。两组并发症相似（29.8%比 22.1%，P=0.07），包括急诊就诊、再入院和/或再次手术的发生率相似。
在 MIRPE 中使用冷冻镇痛似乎可以有效降低术后阿片类药物的需求和 LOS，而不会增加并发症发生率。除了术前加巴喷丁外，其他辅助手段似乎增加了并不能有效减少阿片类药物的使用。对于接受这种手术的患者，应考虑使用冷冻镇痛。
