Clinical PaperIntraoperative cryoanalgesia for managing pain after the Nuss procedure

BackgroundCryoanalgesia prevents pain by freezing the affected peripheral nerve. We report the use of intraoperative cryoanalgesia during the Nuss procedure for pectus excavatum and describe our initial experience, modifications of technique, and lessons learned.Materials and methodsWe retrospectively reviewed the medical records of patients who received cryoanalgesia during the Nuss procedure between June 1, 2015, and April 30, 2016, at our institutions and analyzed modifications in surgical technique during this early adoption period.ResultsEight male and two female patients underwent the Nuss procedure with cryoanalgesia. The mean postoperative length of stay (LOS) was 2 days (range 1-3). Average inpatient pain scores were 3.4, 3.2, and 4.6 on postoperative days 1-3, respectively (N = 10, 7, and 2). At a 1-week postoperative visit, mean pain score was 1.1 (N = 6). Compared to the preceding 15 Nuss patients at our institution, who were treated with a thoracic epidural, postoperative LOS was significantly shorter with cryoanalgesia (2.0 ± 0.82 vs. 6.3 ± 1.3 days, P < 0.001). We modified our technique for patient habitus and adopted single-lung ventilation for improved visualization.ConclusionsCryoanalgesia may be the ideal pain management strategy for Nuss patients because it is effective and long lasting. Intraoperative application is easily integrated into the Nuss procedure.Study typeTreatment study: case series; Evidence level IV.