Division Chair Mayo Clinic Phoenix, Arizona, United States
Disclosure(s):
Dawn Jaroszewski: No relevant disclosure to display
Purpose: Pain control after minimally invasive repair of pectus excavatum (MIRPE) can be challenging especially in adult patients with a more rigid chest wall. This study was conducted to review different analgesic modalities utilized over >10 years including epidural, elastomeric continuous infusion subcutaneous catheters (SC-Cath), and intercostal nerve cryoablation (Cryo). Methods: A retrospective review of electronic medical records was performed of consecutive adult patients (≥18 years old) who underwent primary MIRPE at a single institution from October 2010 to December 2021. Patients with open, hybrid, revision procedures, or additional procedures including repair of fractures were excluded due to potential additional pain stimulus. Patients were classified into 3 groups according to analgesic modality: Epidural; SC-Cath; and Cryo. Short and mid-term outcomes were analyzed, including duration of surgery, length of hospital stay, in-hospital use of narcotics, and 30-day complications. Medications administered intraoperative were excluded from analysis. Most patients additionally participated in enhanced recovery pathways. Comparisons among 3 groups were performed using analysis of variance (ANOVA) or Kruskal-Wallis Test (according to variables distribution) or chi-square for categorical variables. Continuous data are reported as mean ± standard deviation or median (interquartile range) according to distribution, and categorical variables are reported as count (percentage). Results: In total, 729 patients were included (mean age 30.9 ±10.3 years old, 67.1% males, Haller Index 4.8 ±3.0). Table 1 reviews findings. Patients in the Cryo group required significantly lower doses of morphine equivalents (p < 0.001) during their hospitalization and had the shortest hospital stay (mean 1.9 ±1.5 days, p< 0.001 for the comparison) with < 17% staying more than 2 days (versus Epidural 94% and SC-Cath 48%, p< 0.001 for the comparison). There was a lower incidence of complications related to constipation and ileus (p < 0.001) in the Cryo group, however a higher incidence of pleural effusions requiring thoracentesis (p=0.024). There were no other significant differences found regarding complications. The higher incidence of pleural effusions associated with Cryo may have been influenced by a higher number of patients having more than 2 bars placed in the Cryo group (49% versus 40% Epidural and 30% SC-Cath, p< 0.001). Conclusion: The use of Cryo in conjunction with enhanced recovery pathways provided significant benefit to our MIRPE patients compared to prior analgesic modalities. These benefits included a decrease in the length of hospital stay, a reduction of in-hospital use of opioids, and a lower incidence of complications associated with constipation and ileus—which included emergency room visits. Studies including long term follow up after discharge warrant further investigation to assess additional potential benefits of its use.
Identify the source of the funding for this research project: none
