Is cryoanalgesia superior to thoracic epidural analgesia for postoperative recovery after the nuss procedure? An updated meta-analysis

Background: The Nuss procedure is commonly used to correct pectus excavatum, with cryoanalgesia (CA) and thoracic epidural analgesia (TEA) as pain management options. While a prior meta-analysis showed shorter hospital stays with CA, publication of recent studies warrants a more comprehensive evaluation of outcomes not previously reported. Methods: A literature search identified studies comparing CA and TEA in Nuss procedures. Pooled odds ratios, mean differences (MDs), and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using RevMan 8.13.0, with a subgroup analysis of randomized and propensity matched studies. Results: < 0.001). The subgroup analysis corroborated these findings, demonstrating shorter hospital stay with no differences in complication rates. Conclusions: Consistent with the prior meta-analysis, the authors' updated meta-analysis indicates that CA is associated with reduced hospital stay. Additionally, their analysis revealed that CA lowers postoperative pain and opioid consumption, however, the increased costs necessitate a cost-benefit evaluation.