Intercostal nerve cryoablation or epidural analgesia for multimodal pain management after the Nuss procedure: a cohort study

Background Nuss procedure for pectus excavatum is a minimally invasive, but painful procedure. Recently, intercostal nerve cryoablation has been introduced as a pain management technique. Materials and methods In this cohort study, we compared the efficacy of multimodal pain management strategies in children undergoing a Nuss procedure. The effectiveness of intercostal nerve cryoablation combined with patient-controlled systemic opioid analgesia (PCA) was compared to continuous epidural analgesia (CEA) combined with PCA. The study was conducted between January 2019 and July 2022. Primary outcome was length of stay (LOS), secondary outcomes were operation room time, postoperative pain, opioid consumption and gabapentin use. Results Sixty-six consecutive patients were included, 33 patients in each group. The cryoablation group exhibited lower Numeric Rating Scale (NRS) pain scores on postoperative day one and two (p=.002, p=.001) and a shorter LOS (three versus six days (p<.001)). Cryoablation resulted in less patients requiring opioids at discharge (30.3% versus 97.0% (p<.001)) and one week after surgery (6.1% versus 45.4% (p<.001)). In the CEA group gabapentin use was more prevalent (78.8% versus 18.2%, p<.001) and the operation room time was shorter (119.4 versus 135.0 minutes (p<.010)). No neuropathic pain was reported. Conclusions Intercostal nerve cryoablation is a superior analgesic method compared to CEA, with reduced LOS, opioid use and NRS pain scores. The prophylactic use of gabapentin is redundant.