AI Article Synopsis
- The study evaluated the impact of switching from paravertebral nerve blocks (PVBs) to intercostal nerve cryoablation (INC) for pain management after minimally invasive repair of pectus excavatum (MIRPE) at a pediatric center from 2018 to 2023.
- A total of 255 patients were analyzed, showing that while INC led to longer operative times, it significantly reduced the length of hospital stay and both inpatient and outpatient opioid prescriptions.
- The findings suggest that INC effectively decreases opioid use after MIRPE without increasing complication rates, marking a positive change in the postoperative care approach.
Article Abstract
Background: Our institution recently transitioned from paravertebral nerve blocks (PVBs) to intercostal nerve cryoablation (INC) for pain control following minimally invasive repair of pectus excavatum (MIRPE). This study aimed to determine how INC affected the operative time, length of stay, complication rates, inpatient opioid use, and outpatient prescription of opioids at a single center.
Methods: A retrospective review was performed at a single pediatric referral center of all patients who underwent MIRPE between 2018 and 2023. Patient demographics, operative details, and perioperative course were collected. The use of INC versus PVB was recorded. Univariate analyses were performed using Wilcoxon rank sum tests for continuous variables and chi-squared tests for categorical variables.
Results: 255 patients were included with a median age of 15 years, median BMI of 18.50 kg/m, and median Haller index of 4.40. INC was utilized in 41% (105/255), and 59% (150/255) received PVB. The two groups did not differ significantly in BMI, Haller index, or complications, though the INC patients were older by 1 year (15.0 vs. 16.0, p = 0.034). INC was associated with an increased operative time (INC: 92 min vs. PVB: 67 min, p < 0.001), decreased length of stay (3 vs. 4 days, p = < 0.001), more than twofold decrease in inpatient opioids per day (INC: 16 MME vs. PVB: 41 MME, p < 0.001), and a fourfold decrease in the amount of opioids prescribed at discharge (INC: 90 MME vs. PVB: 390 MME, p < 0.001).
Conclusion: INC after MIRPE significantly decreased both the inpatient opioid utilization and our outpatient prescribing practices while also decreasing our overall length of stay without increasing complications.
Level Of Evidence: Level III.
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| http://dx.doi.org/10.1007/s00383-024-05838-2 | DOI Listing |
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