Nationwide Comparison of Epidural and Regional Analgesia Versus Intercostal Nerve Cryoablation in Pectus Repair

Abstract

Introduction: Pectus excavatum is the most common congenital chest wall deformity, occurring in 1 in 250-300 live births. Surgical correction of this pathology is traditionally associated with significant pain. We hypothesize intercostal nerve cryoablation is a superior analgesic modality that can improve patient comfort, improve healthcare resource utilization, and reduce opioid exposure in a high-risk population.

Methods: The most recently published National Readmissions Database (2016-2020) was queried for patient aged 12-21 years old who underwent Nuss Procedure for pectus excavatum. Patient demographics, hospital factors, and patient outcomes including hospital length of stay, opioid-related complications, readmission, post-operative acute pain, respiratory complications, post-operative bleeding, chest tube insertion, pleural effusion, pneumothorax, and hospital costs were analyzed.

Results: 818 patients were analyzed in this study. 62 % received epidural/regional analgesia and 38 % received intercostal nerve cryoablation. The mean age in the cohort was 16 ± 2 years old. 86 % of the study cohort was male. Intercostal nerve cryoablation was associated with significantly reduced opioid-related complications (4.3 % vs 8.7 %, p = 0.015), hospital length of stay (2 [2-3] vs 4 [3-5] days, p < 0.001), and respiratory failure when compared to epidural analgesia. Intercostal nerve cryoablation was associated with an increased index hospitalization cost when compared to epidural/regional analgesia ($17,656 [15,103-23,346] vs. $15,669 [12,676-20,177], p < 0.001).

Conclusion: Intercostal nerve cryoablation for pectus excavatum repair is a safe analgesic modality that is associated with superior pain control while reducing opioid-related complications, respiratory failure, and hospital length of stay.

Type of study: Retrospective Comparative.

Level of evidence: III.

Keywords: Analgesia; Intercostal nerve cryoablation; Nuss; Opioids; Pectus excavatum.