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J Pediatr Surg. 2019 Oct 25. pii: S0022-3468(19)30662-1. doi: 10.1016/j.jpedsurg.2019.09.016. [Epub ahead of print]

Use of Cryoanalgesia for Pain Management for the Modified Ravitch Procedure in Children.

Author information

1
Pediatric Surgery Section, University of Michigan, Ann Arbor, MI, 48109, USA.
2
Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA.
3
Pediatric Surgery Section, University of Michigan, Ann Arbor, MI, 48109, USA. Electronic address: samirg@med.umich.edu.

Abstract

BACKGROUND:

Intercostal cryoablation(IC) for pain management in children undergoing Nuss Procedure has been previously described. We evaluated postoperative outcomes following Modified Ravitch procedure for pectus disorders comparing IC to thoracic epidural(TE).

MATERIALS AND METHODS:

Single-center retrospective review of pediatric patients (age < 21) undergoing Modified Ravitch procedure (January 2015-March 2019) with either IC(9), or TE(20) analgesia. Primary outcome was length of stay (LOS) and secondary outcomes were inpatient opioid use (in oral morphine equivalents per kilogram; OME/kg), pain scores on each postoperative day (POD), discharge prescriptions, and complications. Pairwise comparisons made with Mann-Whitney U test or Fisher Exact test as appropriate. Two-tailed p values <0.05 were considered significant.

RESULTS:

Patient characteristics were similar. LOS was shorter with IC compared to TE (4 days versus 6; p < 0.006). Postoperative opioid use was not significantly different (IC: 1.5 OME/kg versus TE: 1.1; p = 0.10). There was improved pain control on POD 2 in patients who underwent IC (median pain score 3 versus 4; p < 0.0004). There was no difference in discharge prescription (IC: 3.3 OME/kg; TE: 4.8; p = 0.19) or complication rate (IC: 55.6%, TE:50%; p = 1.0).

CONCLUSIONS:

IC during the Modified Ravitch reduced LOS compared to TE with improved pain control starting on POD 2, with similar narcotic utilization and complication rates.

LEVEL OF EVIDENCE:

Treatment Study, Level III (Retrospective comparative study).

KEYWORDS:

Cryoanalgesia; Pain; Pectus; Pediatric; Ravitch; Thoracic

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