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Use of Transthoracic Cryoanalgesia During a Nuss Procedure

Sunghoon Kim¹, Olajire Idowu¹, Sang Lee²

¹UCSF Benioff Children's Hospitals, Oakland, CA, USA

²Regional Medical Center of San Jose, San Jose, CA, USA

 

Purpose: A Nuss procedure is a surgical procedure which causes significant post-operative and long-term pain during the recovery phase.  Cryoanalgesia, which was introduced in 1970s, is an alternate pain relief method that has not been used for the Nuss procedure.   One advantage of cryoanalgesia over other conventional pain relief method is that its analgesic effect lasts for several months with single application.  We describe a thoracoscopic transthoracic cryoanalgesia technique and its analgesia efficacy.

Method: To obtain a direct view of the posterolateral intercostal nerves of a patient with pectus excavatum, a rigid thoracoscope is placed into the chest contralateral to the chest side that is to be examined.  Prior to the passage of the instruments across the anterior mediastinum, the anterior chest wall is elevated using a T-fastener suture technique.  The patient’s anterior mediastinum is dissected to allow passage of the scope and a cryoprobe across the mediastinum.  Bilateral five or four levels of intercostal nerves, one at the level of the incision and two above and two below the incisions are treated with a cryoprobe for 2 min at -60 degrees C.  After the cryoanalgesia, Nuss procedure is completed.  Use of single lung ventilation facilitates cryoprobe application.

Result:  Six boys underwent the cryoanalgesia and Nuss procedure.  Their average age was 14.  The mean Haller index was 4.95.  The mean length of postoperative length of stay was 1.5 days.  Mean pain score on the day of discharge was 1.8 out 10.  Mean pain score on POD #7 was 1 out of 10.  Sensation to the anterior chest returned in 2-3 months.  No neuralgia pain was observed during the three months.

Conclusion:  We present another analgesia technique that could be applied for the Nuss procedure.  The long-term analgesic effect of cryoanalgesia decreases the morbidity of pain for patients recovering from a Nuss procedure. 

Keywords: cryoanalgesia, Nuss procedure