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Eur J Pediatr Surg 2023; 33(01): 061-067
DOI: 10.1055/s-0042-1757361
Original Article

Ultrasound-Guided Percutaneous Cryoanalgesia for Pectus Excavatum: When Should It be Applied?

María Velayos
1   Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
,
Mercedes Alonso
2   Departament of Anesthesia, La Paz University Hospital, Madrid, Spain
,
Karla Estefanía
1   Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
,
Antonio Jesus Muñoz 
1   Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
,
Raquel Torres
3   Pain Unit Nursery, La Paz University Hospital, Madrid, Spain
,
Francisco Hernández
1   Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
,
Francisco Reinoso
2   Departament of Anesthesia, La Paz University Hospital, Madrid, Spain
,
Carlos De la Torre
1   Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
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Abstract

Introduction The addition of ultrasound-guided percutaneous cryoanalgesia (PCr) for pain management after pectus excavatum (PE) surgery offers a new and advantageous approach. Our aim is to describe our experience with PCr applied on the same day, 24 hours, and 48 hours prior to PE surgery.

Material and Methods Prospective pilot study in patients undergoing ultrasound-guided PCr (2019–2022) was divided into three groups: PCr on the same day of surgery (PCrSD), PCr 24 hours before (PCr24), and PCr 48 hours before (PCr48). We describe the application of technique and data obtained by comparing the three groups.

Results We present 42 patients (25 PCrSD, 11 PCr24, 6 PCr48). PCr24 had a shorter procedure duration than PCrSD (65.8 vs. 91.2 minute; p = 0.048). Related to analgesia, PCr24 and PCr48 showed lower opioid consumption than PCrSD in PCA volume (48.5 and 49.6 vs. 75.1 mL; p = 0.015) and PCA time (23.3 and 23.8 vs. 34.3 hours; p = 0.01). Degree of pain (VAS scale) on the day of surgery and on the second postoperative day was lower in PCr24 and PCr48 than in PCrSD (4 and 2 vs. 5; p = 0.012; 0 and 1 vs. 2; p = 0.01, respectively) as well as shorter hospital stay (3 and 3.5 vs. 5 days; p = 0.021). In addition, PCr24 showed lower opioid consumption and hospital stay than PCr48 (p > 0.05). The greatest savings in hospital costs were obtained in the PCr24 group.

Conclusion PCr48 and PCr24 prior to PE surgery offers lower opioid consumption, less pain and shorter hospital stay than PCrSD. PCr24 is comparable to PCr48, but seems to show advantages and simpler logistics for the patient and the hospital.

Keywords

pectus excavatum - percutaneous - cryoanalgesia - patient-controlled analgesia


Publication History

Received: 02 June 2022

Accepted: 26 August 2022

Article published online:
18 October 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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