One- versus Two-Minute Intercostal Nerve Cryoanalgesia in Children Undergoing Surgery for Funnel Chest Deformity
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Patients
- -
- Thoracic deformity other than funnel chest;
- -
- Advanced chronic respiratory or circulatory failure;
- -
- Emergency surgery or reoperation;
- -
- History of thoracotomy or thoracic surgery;
- -
- Mental impairment precluding communication with the patient or lack of consent for cryoanalgesia or regional analgesia;
- -
- History of allergy to local anaesthetic;
- -
- History of taking medication for chronic pain [15].
2.2. Preparation for Surgery
2.3. Anaesthesia
2.4. Surgical Procedure
2.5. Postoperative Course
2.6. Definitions
2.7. Outcomes
- -
- Acute pain intensity (maximum) up to the first 24 h after surgery, based on the patients performing a self-assessment every 1 h for 24 h using the NRS numerical scale (0–10 points) and reporting to the nurse;
- -
- Acute pain intensity (maximum) on the first day after surgery, based on the patients performing a self-assessment every 1 h for 24 h (then every day for 14 days) using the NRS numerical scale (0–10 points) and referring to the parent;
- -
- Length of time in which there was a need for intravenous opioid administration (days after surgery);
- -
- Quality of post-operative rehabilitation in terms of accuracy of exercises and achievement of physical activity independence (days after surgery), based on self-assessment;
- -
- Duration of surgery from skin incision to skin suture (minutes);
- -
- Length of stay (LOS) in hospital (days);
- -
- Occurrence of adverse reactions to pharmacotherapy and anaesthesia;
- -
Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Adverse Effects
3.3. Pain and Sensory Assessment
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Ashcraft, K.W.; Holcomb, G.W.; Murphy, J.P.; Ostlie, D.J. Ashcraft’s Pediatric Surgery, 6th ed.; Saunders/Elsevier: New York, NY, USA, 2014. [Google Scholar]
- Linton, S.C.; Ghomrawi, H.M.; Tian, Y.; Many, B.T.; Vacek, J.; Bouchard, M.E.; De Boer, C.; Goldstein, S.D.; Abdullah, F. Association of operative volume and odds of surgical complication for patients undergoing repair of pectus excavatum at children’s hospitals. J. Pediatr. 2022, 244, 154–160. [Google Scholar] [CrossRef] [PubMed]
- Delande, S.; Lavand’homme, P. Acute pain management and long term outcomes. Curr. Opin. Anaesthesiol. 2023, 36, 222–227. [Google Scholar] [CrossRef] [PubMed]
- van Boekel, R.; Vissers, K.; van der Sande, R.; Bronkhorst, E.; Lerou, J.; Steegers, M. Moving beyond pain scores: Multidimensional pain assessment is essential for adequate pain management after surgery. PLoS ONE 2017, 12, e0177345. [Google Scholar] [CrossRef] [PubMed]
- de Loos, E.; Pennings, A.; van Roozendaal, L.; Daemen, J.; van Gool, M.; Lenderink, T.; van Horck, M.; Hulsewe, K.; Vissers, Y. Nuss Procedure for Pectus Excavatum: A Comparison of Complications between Young and Adult Patients. Ann. Thorac. Surg. 2021, 112, 905–911. [Google Scholar] [CrossRef] [PubMed]
- Cettler, M.; Zielińska, M.; Rosada-Kurasińska, J.; Kubica-Cielińska, A.; Jarosz, K.; Bartkowska-Śniatkowska, A. Guidelines for treatment of acute pain in children—The consensus statement of the Section of Paediatric Anaesthesiology and Intensive Therapy of the Polish Society of Anaesthesiology and Intensive Therapy. Anaesthesiol. Intensive Ther. 2022, 54, 197–218. [Google Scholar] [CrossRef] [PubMed]
- Zhou, L.; Kambin, P.; Casey, K.F.; Bonner, F.J.; O’Brien, E.; Shao, Z.; Ou, S. Mechanism research of cryoanalgesia. Neurol. Res. 1995, 17, 307–311. [Google Scholar] [CrossRef] [PubMed]
- Erinjeri, J.P.; Clark, T.W. Cryoablation: Mechanism of action and devices. J. Vasc. Interv. Radiol. 2010, 21, S187–S191. [Google Scholar] [CrossRef] [PubMed]
- Moorjani, N.; Zhao, F.; Tian, Y.; Liang, C.; Kaluba, J.; Maiwand, M.O. Effects of cryoanalgesia on post-thoracotomy pain and on the structure of intercostal nerves: A human prospective randomized trial and a histological study. Eur. J. Cardiothorac. Surg. 2001, 20, 502–507. [Google Scholar] [CrossRef] [PubMed]
- Kim, S.; Idowu, O.; Palmer, B.; Lee, S.H. Use of transthoracic cryoanalgesia during the Nuss procedure. J. Thorac. Cardiovasc. Surg. 2016, 151, 887–888. [Google Scholar] [CrossRef] [PubMed]
- Hsu, M.; Stevenson, F.F. Wallerian degeneration and recovery of motor nerves after multiple focused cold therapies. Muscle Nerve. 2015, 51, 268–275. [Google Scholar] [CrossRef] [PubMed]
- Gallardo, C.C.; Martínez, J.; Bellía-Munzon, G.; Nazar, M.; Sanjurjo, D.; Toselli, L.; Martínez-Ferro, M. Thoracoscopic cryoanalgesia: A new strategy for postoperative pain control in minimally invasive pectus excavatum repair. Cir. Pediatr. 2020, 33, 11–15. [Google Scholar]
- Katz, J.; Nelson, W.; Forest, R.; Bruce, D. Cryoanalgesia for post-thoracotomy pain. Lancet 1980, 1, 512–513. [Google Scholar] [CrossRef]
- Zeineddin, S.; Goldstein, S.; Linton, S.; DeBoer, C.h.; Alayleh, A.; Ortiz, I.; Sands, L.; Kujawa, S.; Suresh, S.; Ghomrawi, H.; et al. Effectiveness of one minute per level intercostal nerve cryoablation for postoperative analgesia after surgical correction of pectus excavatum. J. Pediatr. Surg. 2023, 58, 34–40. [Google Scholar] [CrossRef]
- Zacha, S.; Andrzejewska, A.; Jastrzębska-Ligocka, B.; Szwed, A.; Modrzejewska, E.; Zacha, W.; Skonieczna-Żydecka, K.; Miegoń, J.; Jarosz, K.; Biernawska, J. Intercostal nerve cryoanalgesia in the treatment of pain in patients operated on by the modified Nuss method with the BackOnFeet application-a new strategy to improve outcomes. Front. Pediatr. 2023, 10, 1069805. [Google Scholar] [CrossRef] [PubMed]
- Zacha, S.; Jarosz, K.; Kokot, K.; Biłas, J.; Skonieczna-Żydecka, K.; Gerus, S.; Kojder, K.; Biernawska, J. Benefits of the Erector Spinae Plane Block before Cryoanalgesia in Children Undergoing Surgery for Funnel Chest Deformity. J. Pers. Med. 2023, 13, 1696. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Chin, K.J.; Versyck, B.; Pawa, A. Ultrasound-guided fascial plane blocks of the chest wall: A state-of-the-art review. Anaesthesia 2021, 76, 110–126. [Google Scholar] [CrossRef] [PubMed]
- Krasopoulos, G.; Dusmet, M.; Ladas, G.; Goldstraw, P. Nuss procedure improves the quality of life in young male adults with pectus excavatum deformity. Eur. J. Cardiothorac. Surg. 2006, 29, 1–5. [Google Scholar] [CrossRef]
- Aly, M.R.; Farina, J.M.; Botros, M.M.; Jaroszewski, D.E. Minimally invasive repair of pectus excavatum in adults: A review article of presentation, workup, and surgical treatment. J. Thorac. Dis. 2023, 15, 5150–5173. [Google Scholar] [CrossRef]
- Raja, S.N.; Carr, D.B.; Cohen, M.; Finnerup, N.B.; Flor, H.; Gibson, S.; Keefe, F.J.; Mogil, J.S.; Ringkamp, M.; Sluka, K.A.; et al. The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises. Pain 2020, 161, 1976–1982. [Google Scholar] [CrossRef]
- Akinboro, S.; John, R.; Reyna, T.; Davis, R.; Ayoub, C.; Sangster, R.; Kim, J.; Nguyen, H.; Moreno, C.; Guner, Y.; et al. A pilot study of multi-modal pain management for same-day discharge after minimally invasive repair of pectus excavatum (Nuss procedure) in children. Pediatr. Surg. Int. 2023, 39, 159. [Google Scholar] [CrossRef]
- Dekonenko, C.; Dorman, R.M.; Duran, Y.; Juang, D.; Aguayo, P.; Fraser, J.D.; Oyetunji, T.A.; Snyder, C.L.; Holcomb, G.W.; Millspaugh, D.L.; et al. Postoperative pain control modalities for pectus excavatum repair: A prospective observational study of cryoablation compared to results of a randomized trial of epidural vs patient-controlled analgesia. J. Pediatr. Surg. 2020, 55, 1444–1447. [Google Scholar] [CrossRef] [PubMed]
- Graves, C.E.; Moyer, J.; Zobel, M.J.; Mora, R.; Smith, D.; O’Day, M.; Padilla, B.E. Intraoperative intercostal nerve cryoablation during the Nuss procedure reduces length of stay and opioid requirement: A randomized clinical trial. J. Pediatr. Surg. 2019, 54, 2250–2256. [Google Scholar] [CrossRef] [PubMed]
- Lai, K.; Notrica, D.M.; McMahon, L.E.; Kang, P.; Molitor, M.S.; Egan, J.C.; Bae, J.-O.; Hunteman, Z.M.; Ostlie, D.J.; Lee, J.H.; et al. Cryoablation in 350 Nuss Procedures: Evolution of Hospital Length of Stay and Opioid Use. J. Pediatr. Surg. 2023, 58, 1435–1439. [Google Scholar] [CrossRef] [PubMed]
- Morikawa, N.; Laferriere, N.; Koo, S.; Johnson, S.; Woo, R.; Puapong, D. Cryoanalgesia in Patients Undergoing Nuss Repair of Pectus Excavatum: Techniqu Modification and Early Results. J. Laparoendosc. Adv. Surg. Tech. A 2018, 28, 1148–1151. [Google Scholar] [CrossRef] [PubMed]
- Torre, M.; Mameli, L.; Bonfiglio, R.; Guerriero, V.; Derosas, L.; Palomba, L.; Disma, N. A New Device for Thoracoscopic Cryoanalgesia in Pectus Excavatum Repair: A Preliminary Single Center Experience. Front. Pediatr. 2021, 8, 614097. [Google Scholar] [CrossRef] [PubMed]
- Jakubów, P.; Kościuczuk, U.; Kosel, J.; Turczynowicz, A.; Luchowski, K.; Tałałaj, M.; Kondracka, J. Zastosowanie metody kriolezji w medycynie paliatywnej. Med. Paliatywna 2020, 13, 9–18. [Google Scholar] [CrossRef]
- Eldredge, R.S.; Ochoa, B.; Khoury, E.; Mihalcin, K.; Ostlie, D.; Lee, J.; McMahon, L.; Notrica, D.; Padilla, B.E. Long-Term Sensory Function 3 years after Minimally Invasive Repair of Pectus Excavatum with Cryoablation. J. Pediatr. Surg. 2024, 59, 379–384. [Google Scholar] [CrossRef]
- Zobel, M.J.; Ewbank, C.; Mora, R.; Idowu, O.; Kim, S.; Padilla, B.E. The incidence of neuropathic pain after intercostal cryoablation during the Nuss procedure. Pediatr. Surg. Int. 2020, 36, 317–324. [Google Scholar] [CrossRef] [PubMed]
- Walker, S.M. Neuropathic pain in children: Steps towards improved recognition and management. EBioMedicine 2020, 62, 103124. [Google Scholar] [CrossRef] [PubMed]
Parameter [Mean ± SD] | Study Group (n = 33) |
---|---|
Age (years) | 14.6 ± 1.7 |
BMI | 18 ± 1.6 |
Haller index | 3.6 ± 0.45 |
Child survey before surgery (points) | 28 ± 10 |
Parent survey before surgery | 31 ± 6 |
Parameter [Mean ± SD] | Study Group (n = 33) |
---|---|
Surgery time (minutes) | 66.81 ± 14.7 |
Length of hospitalisation (days) | 3.9 ± 0.5 |
Discontinuation of intravenous opioids after 24 h, n (%) | 32 (97) |
MAX NRS 24 h = 1, n (%) | 2 (6) |
MAX NRS 24 h = 2, n (%) | 3 (9) |
MAX NRS 24 h = 3, n (%) | 28 (85) |
Parameter | Right Side—Standard (Points) 2 min per Nerve | Left Side—Intervention (Points) 1 min per Nerve | p |
---|---|---|---|
MAX NRS 1 POD | 6 | 6 | 0.1635 |
MAX NRS 2 POD | 5 | 5 | 0.4054 |
MAX NRS 3 POD | 5 | 5 | 0.9517 |
MAX NRS 4 POD | 5 | 5 | 0.4101 |
MAX NRS 5 POD | 5 | 4 | 0.3763 |
MAX NRS 6 POD | 4 | 4 | 0.0571 |
MAX NRS 7 POD | 4 | 4 | 0.0884 |
MAX NRS 8 POD | 4 | 4 | 0.4364 |
MAX NRS 9 POD | 3 | 3 | 0.0740 |
MAX NRS 10 POD | 3 | 3 | 0.1635 |
MAX NRS 11 POD | 3 | 3 | 0.0597 |
MAX NRS 12 POD | 2 | 2 | 0.0759 |
MAX NRS 13 POD | 2 | 2 | 0.4762 |
MAX NRS 14 POD | 2 | 2 | 0.0532 |
Hyposensitivity | Right Side Only (n) | Left Side Only (n) | p | Both Sides (n, %) |
---|---|---|---|---|
1 POD | 1 | 2 | 1 | 13 (39) |
2 POD | 2 | 3 | 1 | 15 (45) |
3 POD | 1 | 1 | 1 | 13 (39) |
4 POD | 1 | 2 | 1 | 12 (36) |
5 POD | 1 | 1 | 1 | 14 (42) |
6 POD | 1 | 2 | 1 | 10 (30) |
7 POD | 3 | 1 | 0.62 | 8 (24) |
8 POD | 2 | 1 | 1 | 7 (21) |
9 POD | 1 | 2 | 1 | 5 (15) |
10 POD | 1 | 2 | 1 | 6 (18) |
11 POD | 3 | 1 | 0.62 | 6 (18) |
12 POD | 2 | 0 | 0.5 | 6 (18) |
13 POD | 1 | 1 | 1 | 6 (18) |
14 POD | 1 | 1 | 1 | 6 (18) |
Hypersensitivity | Right Side Only (n) | Left Side Only (n) | p | Both Sides (n, %) |
---|---|---|---|---|
1 POD | 1 | 1 | 1 | 6 (18) |
2 POD | 2 | 1 | 1 | 3 (9) |
3 POD | 1 | 2 | 1 | 4 (12) |
4 POD | 2 | 1 | 1 | 4 (12) |
5 POD | 0 | 1 | 1 | 5 (15) |
6 POD | 1 | 2 | 1 | 7 (21) |
7 POD | 1 | 3 | 0.62 | 8 (24) |
8 POD | 3 | 1 | 0.6 | 10 (30) |
9 POD | 3 | 2 | 1 | 9 (28) |
10 POD | 3 | 3 | 1 | 7 (21) |
11 POD | 2 | 2 | 1 | 5 (15) |
12 POD | 3 | 2 | 1 | 4 (12) |
13 POD | 1 | 0 | 1 | 6 (18) |
14 POD | 1 | 1 | 1 | 5 (15) |
Numbness | Right Side Only (n) | Left Side Only (n) | p | Both Sides (n, %) |
---|---|---|---|---|
1 POD | 0 | 0 | - | 4 (12) |
2 POD | 1 | 1 | 1 | 4 (12) |
3 POD | 2 | 1 | 1 | 4 (12) |
4 POD | 1 | 0 | 1 | 4 (12) |
5 POD | 3 | 0 | 0.25 | 2 (6) |
6 POD | 4 | 0 | 0.12 | 1 (3) |
7 POD | 2 | 0 | 0.5 | 2 (6) |
8 POD | 1 | 0 | 1 | 3 (9) |
9 POD | 2 | 0 | 0.5 | 3 (9) |
10 POD | 1 | 0 | 1 | 1 (3) |
11 POD | 0 | 0 | - | 1 (3) |
12 POD | 0 | 1 | 1 | 2 (6) |
13 POD | 0 | 0 | - | 1 (3) |
14 POD | 0 | 0 | - | 1 (3) |
Parameter (n, %) | Study Group (n = 32) |
---|---|
Full activity | 32 (100) |
Pain at rest | 1 (3) |
Pain during activity | 6 (18) |
Hyposensitivity | 10 (31) |
Hypersensitivity | 6 (18) |
Neuropathic pain DN4 | 0 |
Child survey (after–before surgery) * | 18 (47–27) |
Parent survey (after–before surgery) * | 19 (50–30) |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Zacha, S.; Lopez, M.; Bilas, J.; Skonieczna-Żydecka, K.; Miegoń, J.; Biernawska, J. One- versus Two-Minute Intercostal Nerve Cryoanalgesia in Children Undergoing Surgery for Funnel Chest Deformity. J. Pers. Med. 2024, 14, 875. https://doi.org/10.3390/jpm14080875
Zacha S, Lopez M, Bilas J, Skonieczna-Żydecka K, Miegoń J, Biernawska J. One- versus Two-Minute Intercostal Nerve Cryoanalgesia in Children Undergoing Surgery for Funnel Chest Deformity. Journal of Personalized Medicine. 2024; 14(8):875. https://doi.org/10.3390/jpm14080875
Chicago/Turabian StyleZacha, Sławomir, Manuel Lopez, Jarosław Bilas, Karolina Skonieczna-Żydecka, Jakub Miegoń, and Jowita Biernawska. 2024. "One- versus Two-Minute Intercostal Nerve Cryoanalgesia in Children Undergoing Surgery for Funnel Chest Deformity" Journal of Personalized Medicine 14, no. 8: 875. https://doi.org/10.3390/jpm14080875