Eur J Pediatr Surg 2022; 32(01): 073-079
DOI: 10.1055/s-0041-1740555
Original Article

Percutaneous Cryoanalgesia: A New Strategy for Pain Management in Pectus Excavatum Surgery

1   Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain
,
Mercedes Alonso
2   Children's Anesthesia and Resuscitation Department, La Paz University Hospital, Madrid, Spain
,
1   Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain
,
Karla Estefanía-Fernández
1   Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain
,
1   Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain
,
Manuel V. López Santamaría
1   Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain
,
Francisco Reinoso-Barbero
2   Children's Anesthesia and Resuscitation Department, La Paz University Hospital, Madrid, Spain
,
Carlos A. De La Torre
1   Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain
› Author Affiliations
Funding Dr. María Velayos reports support for the present manuscript (e.g., funding, provision of study materials, medical writing, article processing charges, etc.) and receipt of equipment, materials, drugs, medical writing, gifts, or other services from MedXpert Universal System and Metrum Cryoflex.

Abstract

Introduction In recent years, pain protocols for pectus excavatum (PE) have incorporated cryoanalgesia through thoracoscopic approach. Since 2019, ultrasound-guided percutaneous cryoanalgesia (PCr) has been applied at our institution, either on the same day as the Nuss procedure or 48 hours before surgery. We carried out a preliminary retrospective review of patients with PE in whom PCr prior to surgery was performed at our institution between 2019 and 2021.

Materials and Methods Two groups were evaluated: PCr on the same day (PCrSD) and PCr 48 hours before surgery (PCr48). Despite PCr, patients were treated with “patient-controlled analgesia” (PCA) with opioids for at least 24 hours, switching to conventional intravenous analgesia and oral analgesia in the following days. Demographic, clinical-radiological variables, PCA opioid use, pain grade according to the visual analog scale (VAS), and length of stay (LOS) were compared between the groups. A total of 20 patients were included (12 with PCrSD and 8 with PCr48), without significant differences in demographics or clinical-radiological variables. The overall median time of PCr was 65 minutes (55–127), with no differences between the groups.

Results PCr48 group presented with significantly lower median number of hours of continuous PCA (24 vs. 32 hours; p = 0.031), lower median number of rescue boluses (11 vs. 18; p = 0.042), lower median VAS in the early postoperative hours (2 vs. 5.5; p = 0.043), and lower median LOS (3.5 vs. 5 days).

Conclusion PCr performed 48 hours prior to surgery is more effective in terms of PCA requirements, VAS, and LOS when compared with cryoanalgesia on the same day.



Publication History

Received: 17 July 2021

Accepted: 21 October 2021

Publication Date:
23 December 2021 (online)

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