Multicenter assessment of cryoanalgesia use in minimally invasive repair of pectus excavatum: A 20-center retrospective cohort study

Authors

Seyed A. Arshad, McGovern Medical School at the University of Texas Health Science Center at Houston, United States
Elisa I. Garcia, McGovern Medical School at the University of Texas Health Science Center at Houston, United States
Cynthia Bell, McGovern Medical School at the University of Texas Health Science Center at Houston, United States
Elenir B C. Avritscher, McGovern Medical School at the University of Texas Health Science Center at Houston, United States
Mohineesh Kumar, Beaumont Health/Beaumont Children's, United States
Pavan Brahmamdam, Beaumont Health/Beaumont Children's, United States
James A. Fraser, Children's Mercy Kansas City, United States
Shawn D. St Peter, Children's Mercy Kansas City, United States
Arturo Aranda, Dayton Children's Hospital, United States
Saleem Islam, University of Florida/Shands Children's Hospital, United StatesFollow

Document Type

Article

Department

Paediatric Surgery

Abstract

Objective: To assess the clinical implications of cryoanalgesia for pain management in children undergoing minimally invasive repair of pectus excavatum (MIRPE).
Background: MIRPE entails significant pain management challenges, often requiring high postoperative opioid use. Cryoanalgesia, which blocks pain signals by temporarily ablating intercostal nerves, has been recently utilized as an analgesic adjunct. We hypothesized that the use of cryoanalgesia during MIRPE would decrease postoperative opioid use and length of stay (LOS).
Materials and methods: A multicenter retrospective cohort study of 20 US children's hospitals was conducted of children (age below 18 years) undergoing MIRPE from January 1, 2014, to August 1, 2019. Differences in total postoperative, inpatient, oral morphine equivalents per kilogram, and 30-day LOS between patients who received cryoanalgesia versus those who did not were assessed using bivariate and multivariable analysis. P value <0.05 is considered significant.
Results: Of 898 patients, 136 (15%) received cryoanalgesia. Groups were similar by age, sex, body mass index, comorbidities, and Haller index. Receipt of cryoanalgesia was associated with lower oral morphine equivalents per kilogram (risk ratio=0.43, 95% confidence interval: 0.33-0.57) and a shorter LOS (risk ratio=0.66, 95% confidence interval: 0.50-0.87). Complications were similar between groups (29.8% vs 22.1, P=0.07), including a similar rate of emergency department visit, readmission, and/or reoperation.
Conclusions: Use of cryoanalgesia during MIRPE appears to be effective in lowering postoperative opioid requirements and LOS without increasing complication rates. With the exception of preoperative gabapentin, other adjuncts appear to increase and/or be ineffective at reducing opioid utilization. Cryoanalgesia should be considered for patients undergoing this surgery.

Comments

This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

Annals of Surgery

Recommended Citation

Arshad, S. A., Garcia, E. I., Bell, C., Avritscher, E. C., Kumar, M., Brahmamdam, P., Fraser, J. A., St Peter, S. D., Aranda, A., Islam, S. (2023). Multicenter assessment of cryoanalgesia use in minimally invasive repair of pectus excavatum: A 20-center retrospective cohort study. Annals of Surgery, 277(6), e1373-e1379.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_paediatr/59