Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun;60(6):162282.
doi: 10.1016/j.jpedsurg.2025.162282. Epub 2025 Mar 21.

Postoperative Pain Management After Minimally Invasive Repair of Pectus Excavatum: A Systematic Review and Network Meta-analysis

Elise J Van Polen  1 , Chiel J Franssen  1 , Jean H T Daemen  1 , Austin J Isabella  1 , Aimée J P M Franssen  1 , Karel W E Hulsewé  1 , Yvonne L J Vissers  1 , Erik R de Loos  2
Affiliations

Postoperative Pain Management After Minimally Invasive Repair of Pectus Excavatum: A Systematic Review and Network Meta-analysis

Elise J Van Polen et al. J Pediatr Surg. 2025 Jun.

Abstract

Background: Minimally invasive repair of pectus excavatum is the accepted standard approach for correction of pectus excavatum. This procedure is associated with significant postoperative pain, which is the dominant factor determining the duration of hospitalization. To date, a multitude of analgesic modalities are used, however, the most effective is to be corroborated. The aim of this study is to systematically evaluate and compare all available analgesic modalities for pain management after minimally invasive repair of pectus excavatum through a network meta-analysis.

Methods: Electronic scientific databases were systematically searched. Articles were eligible for inclusion when designed as a comparative study evaluating perioperative pain management techniques for patients undergoing minimally invasive repair of pectus excavatum and where length of hospitalization was reported as an outcome. Data concerning length of hospitalization were extracted and submitted for network meta-analysis.

Results: Thirty-nine studies were included, enrolling 4241 patients. Through a network meta-analysis intercostal nerve cryoablation with an adjunct analgesic intervention (e.g., intercostal nerve block or patient controlled analgesia) showed a statistically significant reduction in the length of hospitalization ranging from 0.9 days (95 % confidence interval (CI): -1.7 to -0.1) when compared to locoregional blocks with an adjunct analgesic intervention to 2.5 days (95 % CI: -3.7 to -1.3) when compared to thoracic epidural analgesia.

Conclusion: Regarding postoperative pain management after minimally invasive repair of pectus excavatum, intercostal nerve cryoablation with adjunct analgesic intervention is more effective in terms of length of hospitalization compared to other forms of analgesia.

Type of study: Systemic review and meta analysis.

Keywords: Chest wall; Network meta-nalysis; Pectus excavatum; Postoperative analgesia; Systematic review.

PubMed Disclaimer

Publication types

MeSH terms