Eliminating Post-Operative Pain with Intercostal Nerve Cryoablation during Rib Cartilage Harvest for Total Microtia Construction

Postoperative pain management at the rib cartilage harvest site for total microtia construction remains a challenge for many patients, leading to prolonged hospital stays and increased use of post-operative analgesics. Cryoablation of intercostal nerves has been an effective modality of post-operative pain control during pectus excavatum repair, reducing postoperative opioid requirements and decreasing length of hospital stay, without significantly increasing intraoperative time. This technique involves axonotmesis of the intercostal nerves, causing reversible injury with sensory return in approximately 6 months. Given its benefits in pectus excavatum repair, we explored this method of pain control via a percutaneous approach during rib cartilage harvesting for microtia construction. Our experience suggests that this novel application can provide early and sustained analgesia with minimal rib donor site pain as early as postoperative day (POD) 1, without adverse reactions.