Santana Lisgelia, Abels Mario, Driggers John, Carvalho Norman
Department of Anesthesiology, Nemours Children's Hospital, Orlando, Florida, United States.
Medical Student, University of Central Florida College of Medicine, Orlando, Florida, United States.
Eur J Pediatr Surg. 2025 Jun;35(3):240-246. doi: 10.1055/a-2490-1091. Epub 2024 Dec 19.
Erector spinae plane (ESP) blocks, thoracic epidural, and patient-controlled analgesia (PCA) have all been used for perioperative pain management in the Nuss procedure without a consensus on what modality produces the best outcomes. Intercostal nerve cryoablation (INC) is a relatively new modality that involves freezing the nerves to prevent pain during recovery. Our hypothesis is that using INC for the Nuss procedure will decrease opioid use, pain scores, and length of stay (LOS) but will increase cost compared with ESP block, thoracic epidural, and PCA.
This retrospective, observational study compared 108 patients who underwent the Nuss procedure at a pediatric acute care children's hospital in the southeast US. Patient charts were evaluated for significant differences in LOS, opioid use, and reported pain ratings based on type of analgesia administered: INC ( = 30), ESP block ( = 19), thoracic epidural ( = 41), and PCA ( = 18). Secondary variables included emergency department visits, readmissions, opioid refills, and various anesthetic and operative costs. Analysis of variance was performed on all outcome measures.
Average LOS was significantly decreased in the INC group (2.9 days) compared with the thoracic epidural (4.7 days, < 0.05) and the PCA groups (3.7 days, < 0.05). Average cumulative opioid use was significantly decreased in the INC group (50.4 morphine milligram equivalents [MME]) compared with the thoracic epidural (117 MME, < 0.05) and PCA groups (172.1 MME, < 0.05).
This study suggests that INC can be a viable and cost-effective option for reducing postoperative opioid consumption and LOS in Nuss procedure patients. Pain perception was lower in the INC group compared with the rest of the groups, except the epidurals, which were similar. However, the opioid consumption of the INC group was significantly lower than any other group. Despite the INC group having higher initial costs, it did not result in the highest total hospital charges, indicating its potential cost-effectiveness. There is a need for larger prospective randomized controlled trials to guide future research efforts.
竖脊肌平面（ESP）阻滞、胸段硬膜外阻滞和患者自控镇痛（PCA）均已用于鸡胸Nuss手术围手术期的疼痛管理，但对于哪种方式能产生最佳效果尚无共识。肋间神经冷冻消融术（INC）是一种相对较新的方法，通过冷冻神经来预防恢复过程中的疼痛。我们的假设是，与ESP阻滞、胸段硬膜外阻滞和PCA相比，在鸡胸Nuss手术中使用INC将减少阿片类药物的使用、疼痛评分和住院时间（LOS），但会增加成本。
这项回顾性观察性研究比较了美国东南部一家儿科急症儿童医院108例行鸡胸Nuss手术的患者。根据所给予的镇痛类型评估患者病历，以确定住院时间、阿片类药物使用情况和报告的疼痛评分的显著差异：INC组（n = 30）、ESP阻滞组（n = 19）、胸段硬膜外阻滞组（n = 41）和PCA组（n = 18）。次要变量包括急诊科就诊次数、再入院次数、阿片类药物补充次数以及各种麻醉和手术费用。对所有结果指标进行方差分析。
与胸段硬膜外阻滞组（4.7天，P < 0.05）和PCA组（3.7天，P < 0.05）相比，INC组的平均住院时间显著缩短（2.9天）。与胸段硬膜外阻滞组（117吗啡毫克当量[MME]，P < 0.05）和PCA组（172.1 MME，P < 0.05）相比，INC组的平均累积阿片类药物使用量显著减少（50.4 MME）。
本研究表明，在鸡胸Nuss手术患者中，INC可能是减少术后阿片类药物消耗和住院时间的一种可行且具有成本效益的选择。与其他组相比，INC组的疼痛感知较低，但硬膜外阻滞组除外，二者相似。然而，INC组的阿片类药物消耗量显著低于其他任何组。尽管INC组的初始成本较高，但并未导致最高的总住院费用，表明其具有潜在的成本效益。需要开展更大规模的前瞻性随机对照试验来指导未来的研究工作。
