Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
Department of Surgery, Duke University Medical Center, Durham, North Carolina.
J Surg Res. 2023 Nov;291:289-295. doi: 10.1016/j.jss.2023.06.018. Epub 2023 Jul 21.
Pectus excavatum repair by the Nuss procedure results in severe postoperative pain. Regional blocks and intercostal nerve cryoablation (INC) have emerged as potential strategies to manage analgesia. This study compares pain-related outcomes following these perioperative interventions.
We reviewed charts of patients <18 y who underwent the Nuss procedure at Duke Children's Hospital from July 2018 to June 2022. Patients were divided into three groups by analgesic strategy: no block, regional catheters, or INC, representing the chronologic change in our practice. The primary outcome was total and daily in-hospital opioid utilization measured by oral morphine equivalents (OMEs). Secondary outcomes included average daily pain scores, length of stay, opioid refills after discharge, and complications.
Twenty-one patients were included and analyzed: no block (n = 6), regional catheters (n = 7), and INC (n = 8). INC-treated patients required significantly lower total postoperative, in-hospital OMEs (64 ± 47 [mean ± standard deviation]) than those with no block (270 ± 217, P = 0.04) or those with regional catheters (273 ± 176, P = 0.03). INC was associated with longer average operative times (161 ± 36 min) than no block (105 ± 21 min, P = 0.005) or regional catheters (90 ± 11 min, P < 0.001). INC-treated patients had shorter hospital length of stays (median 68 h) than those with regional catheters (median 74 h, P = 0.006).
INC was associated with longer operative times but decreased in-hospital OMEs when compared to bilateral regional block catheters and multimodal analgesia alone.
Nuss 手术修复漏斗胸会导致严重的术后疼痛。区域阻滞和肋间神经冷冻消融（INC）已成为管理镇痛的潜在策略。本研究比较了这些围手术期干预措施后的疼痛相关结果。
我们回顾了 2018 年 7 月至 2022 年 6 月在杜克儿童医院接受 Nuss 手术的<18 岁患者的图表。根据镇痛策略将患者分为三组：无阻滞、区域导管或 INC，代表我们实践中的时间变化。主要结果是通过口服吗啡等效物（OME）测量的总住院期间和每日阿片类药物用量。次要结果包括平均每日疼痛评分、住院时间、出院后阿片类药物的补充情况和并发症。
共纳入并分析了 21 例患者：无阻滞组（n=6）、区域导管组（n=7）和 INC 组（n=8）。INC 治疗组术后总、住院 OME 明显低于无阻滞组（270±217，P=0.04）或区域导管组（273±176，P=0.03）。INC 组的平均手术时间较长（161±36 分钟），明显长于无阻滞组（105±21 分钟，P=0.005）或区域导管组（90±11 分钟，P<0.001）。与区域导管组相比，INC 组患者的住院时间更短（中位数 68 小时）（P=0.006）。
与双侧区域阻滞导管和多模式镇痛相比，INC 与较长的手术时间相关，但减少了住院期间 OME。
