Multicenter Assessment of Cryoanalgesia Use in Minimally Invasive Repair of Pectus Excavatum A 20-center Retrospective Cohort Study

被引：9

作者：

Arshad, Seyed A. ^{[1
,2
,3
,4
]}

Garcia, Elisa, I ^{[1
,2
,3
,4
]}

Bell, Cynthia ^{[1
,4
]}

Avritscher, Elenir B. C. ^{[1
,4
]}

Kumar, Mohineesh ^{[5
]}

Brahmamdam, Pavan ^{[5
]}

Fraser, James A. ^{[6
]}

St Peter, Shawn D. ^{[6
]}

Aranda, Arturo ^{[7
,14
]}

Hill, Madelyn ^{[7
,14
]}

Marquart, John ^{[8
]}

Van Arendonk, Kyle ^{[8
]}

Plumblee, Leah ^{[9
]}

Streck, Christian J. ^{[9
]}

Zamora, Irving J. ^{[10
]}

Ghani, Muhammad O. A. ^{[10
]}

Reichard, Kirk W. ^{[11
]}

Sacks, Karen ^{[11
]}

Kallis, Michelle ^{[12
]}

Hong, Andrew ^{[12
]}

Richards, Holden ^{[13
]}

Lin, Saunders ^{[13
]}

Gross, Erica R.

Kabeer, Mustafa H. ^{[15
]}

Reyna, Troy ^{[15
]}

Paton, Elizabeth A. ^{[16
]}

Camp, Lauren B. ^{[16
]}

Stephenson, Krista ^{[17
]}

Dassinger, Melvin ^{[17
]}

Vali, Kaveh ^{[18
]}

Filipescu, Radu ^{[18
]}

DeUgarte, Daniel A. ^{[19
]}

Krishna, Vikram ^{[19
]}

Slater, Bethany ^{[20
]}

Islam, Saleem ^{[21
]}

Thompson, Grace ^{[21
]}

Moore, James T. ^{[22
]}

Englum, Brian R. ^{[22
]}

Scholz, Stefan ^{[23
]}

Sharbaugh, Elizabeth ^{[23
]}

Gander, Jeffrey W. ^{[24
]}

Tsao, KuoJen ^{[1
,2
,3
,4
]}

机构：

[1] Univ Texas Hlth Sci Ctr Houston, McGovern Med Sch, Houston, TX 77030 USA

[2] Univ Texas Hlth Sci Ctr Houston, McGovern Med Sch, Dept Pediat Surg, Houston, TX 77030 USA

[3] Univ Texas Hlth Sci Ctr Houston, Ctr Surg Trials & Evidence Based Practice C STEP, McGovern Med Sch, Houston, TX 77030 USA

[4] Childrens Mem Hermann Hosp, Houston, TX 77030 USA

[5] Beaumont Childrens, Beaumont Hlth, Beaumont, TX USA

[6] Childrens Mercy Kansas City, Kansas City, MO USA

[7] Dayton Childrens Hosp, Dayton, OH USA

[8] Med Coll Wisconsin, Childrens Hosp Wisconsin, Milwaukee, WI 53226 USA

[9] Med Univ South Carolina, Shawn Jenkins Childrens Hosp, Charleston, SC 29425 USA

[10] Monroe Carell Jr Childrens Hosp Vanderbilt, Dept Pediat Surg, Nashville, TN USA

[11] Nemours AI duPont Hosp Children, Wilmington, DE USA

[12] Northwell Hlth, Cohen Childrens Med Ctr, New York, NY USA

[13] Oregon Hlth & Sci Univ, Doernbecher Childrens Hosp, Portland, OR 97201 USA

[14] Stony Brook Childrens Hosp, Stony Brook Med, Stony Brook, NY USA

[15] Univ Calif Irvine, CHOC Childrens Hosp, Irvine, CA USA

[16] Univ Tennessee, Hlth Sci Ctr, Le Bonheur Childrens Hosp, Knoxville, TN 37996 USA

[17] Univ Arkansas Med Sci, Arkansas Childrens Hosp, Little Rock, AR 72205 USA

[18] SUNY Buffalo, Oishei Childrens Hosp, Buffalo, NY USA

[19] Univ Calif Los Angeles, Mattel Childrens Hosp, Los Angeles, CA 90024 USA

[20] Univ Chicago Med, Chicago, IL USA

[21] Univ Florida, Shands Childrens Hosp, Gainesville, FL 32611 USA

[22] Univ Maryland, Childrens Hosp, Sch Med, College Pk, MD 20742 USA

[23] Univ Pittsburgh, UPMC Childrens Hosp Pittsburgh, Pittsburgh, PA 15260 USA

[24] Univ Virginia, Childrens Hosp, Charlottesville, VA 22903 USA

来源：

ANNALS OF SURGERY | 2023年 / 277卷 / 06期

关键词：

pectus excavatum; minimally invasive repair of pectus excavatum; Nuss procedure; cryoanalgesia; pain control; opioids; length of stay; complications; INTERCOSTAL NERVE CRYOABLATION; NUSS; OUTCOMES;

D O I：

10.1097/SLA.0000000000005440

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

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 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.

引用

页码：E1373 / E1379

页数：7

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