Cryoanalgesia for Paediatric Minimally Invasive Repair of Pectus Excavatum: An Australian Retrospective Comparative Analysis

BACKGROUND: The Nuss procedure, also known as minimally invasive repair of pectus excavatum (MIRPE), is recognised to cause high levels of post-operative pain, requiring regional techniques and inpatient and outpatient opioid use. Intercostal nerve cryoablation during MIRPE is a new technique that results in extended analgesia for up to 3-6 months after surgery. This multisite comparative analysis is the first to present the use of cryoanalgesia in Australasia. METHODS: Retrospective chart reviews were conducted of 17 consecutive patients who underwent cryoanalgesia for MIRPE and 17 patients who underwent MIRPE without cryoanalgesia immediately before its introduction to two sites. Oral morphine equivalents were calculated for opiate medications administered and dispensed. The two cohorts were compared using unpaired t-tests for normally distributed data and Mann-Whitney U tests for non-normally distributed data. RESULTS: Cryoanalgesia significantly shortened the length of stay-median length of stay 3 days in patients who had cryoanalgesia compared to 5 days in patients with no cryoanalgesia (p < 0.05). Cryoanalgesia also significantly reduced inpatient opiate use-average oral morphine equivalent 110 mg in patients who received cryoanalgesia compared to 489 mg in those who did not (p < 0.05). CONCLUSION: Use of cryoanalgesia significantly reduced inpatient opioid use and reduced length of stay. Ongoing research is required to establish the safety of this technique and study the long-term effects.