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. 2025 Jul 25.
doi: 10.1097/SLA.0000000000006855. Online ahead of print.

Intercostal Nerve Cryoablation During Pectus Excavatum Surgery for Postoperative Pain Management: A Systematic Review and Meta-Analysis

David M Notrica  1   2   3 , Lisa E McMahon  1   2   3 , Alyssa Hahn  4 , Nfii Ndikintum  4 , Madelyn Dua  4 , Dawn E Jaroszewski  5
Affiliations

Intercostal Nerve Cryoablation During Pectus Excavatum Surgery for Postoperative Pain Management: A Systematic Review and Meta-Analysis

David M Notrica et al. Ann Surg. .

Abstract

Objective: The objective of this study was to systematically review the literature-reported outcomes of CRYO compared to standard of care without CRYO (non-CRYO) after PEx repair.

Summary background data: Surgical repair of pectus excavatum (PEx) via the Nuss or Ravitch procedures is associated with substantial postoperative pain. Intercostal nerve cryoablation (CRYO) performed during the primary surgical repair has been adopted as a non-opioid modality for pain management.

Methods: A literature search was conducted in PubMed, Embase, and using additional online approaches to identify comparative studies of patients undergoing the Nuss or Ravitch procedure for PEx repair with CRYO versus non-CRYO between years 2014-24. Meta-analysis was performed to quantitatively evaluate primary outcomes of hospital length of stay (LOS) and opioid consumption. Secondary outcomes were hospital costs and complications, summarized qualitatively.

Results: Of 178 studies, 32 comparative studies encompassing 13,103 patients were included; 28% (n=3,620) received CRYO. Random effects meta-analyses demonstrated a significantly shortened LOS by 1.8 days (95% confidence interval [CI]: -2.12, -1.42) and a significant reduction in inpatient and outpatient opioid consumption with CRYO by 186 morphine mg equivalents (MME) (95% CI: -262.26, -109.08) and 147 MME (95% CI: -255.72, -38.26), respectively. Complications with CRYO were either decreased or similar between groups and resolved over time. Hospital costs were similar.

Conclusions: This systematic review suggests CRYO during PEx repair is associated with a significantly shorter hospital LOS, as well as decreased opioid consumption both in the hospital and after discharge. Complications were infrequent and time-limited.

Keywords: Nuss procedure; complications; intercostal nerve cryoablation; meta-analysis; pain management; pectus excavatum repair.

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Conflict of interest statement

Conflicts of Interest and Source of Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Three of the authors are employees of AtriCure.

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