Cryoablation for Nuss procedure pain

By | June 8, 2019

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The Nuss Procedure for the repair of Pectus excavatum is one of the most painful surgical procedures. The chest is an especially sensitive area and the sudden reshaping of the chest wall, including ribs and costal cartilage, can be grueling. Fortunately, there are some new ways to manage that pain.

In a recent study by Graves and colleagues from the University of California, San Fransisco, 20 people undergoing the Nuss Procedure were randomized to receive a thoracic epidural — typically considered standard of care for this surgery — or cryoanalgesia.

Cryoablation involves inserting a cryoprobe through the incision made for the Nuss procedure. The cyroprobe is placed against the nerves that run along each rib, temporarily shutting them down with an applied temperature of -60 degrees Celcius for 2 minutes.

Although cryoanalgesia required about 45 minutes extra in the operating room, it led to reduced hospital length of stay by about 2 days. Cryoablation patients also required about 50% less opioids during the postoperative period.

However, there’s an important caveat. Pain scores did not differ between those receiving an epidural and those receiving cryoanalgesia. So the subjective experience of pain did not increase.

Be sure to ask your surgeon if they have any experience with cryoablation and whether it could be appropriate for you.

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