Abstract：
BACKGROUND: Our study assesses the association between cryoablation, with and without nerve block supplementation, post-Nuss procedure pain, and opioid use in pectus excavatum (PE) patients.
METHODS: We conducted a retrospective cohort study at a single center for PE patients who underwent the Nuss procedure from 2017 to 2022. Outcomes included postoperative opioid use (measured in oral morphine milligram equivalent per kilogram [OME/kg]), average pain score (scale 0-10), and length of stay (LOS).
RESULTS: One hundred sixty-four patients (146 males and 18 females) were included, with 79 (48.2%) receiving neither cryoablation nor nerve block, 60 (36.6%) receiving intraoperative cryoablation alone, and 25 (15.2%) receiving both cryoablation and nerve block. The median age was 16 y. Nerve block recipients consumed fewer opioids during hospitalization than cryoablation alone and nonintervention groups (1.5 versus 2.3 versus 5.8 OME/kg, respectively, P < 0.0001). Average pain scores over the total LOS were lower in nerve block recipients (3.5 versus 3.8 versus 4.2, P = 0.03), particularly on postoperative day 0 (P = 0.002). Nerve block recipients had a shorter LOS than cryoablation alone and nonintervention groups (43.4 versus 54.7 versus 66.2 h, P < 0.0001). On multivariate analysis, cryoablation alone resulted in significantly less opioid use compared to no intervention (3.32 OME/kg reduction, 95% confidence interval -4.16 to -2.47, P < 0.0001). Addition of nerve block further reduced opioid use by 1.10 OME/kg (95% confidence interval -2.07 to -0.14, P = 0.04).
CONCLUSIONS: Cryoablation with nerve block supplementation is associated with reduced pain, opioid use, and LOS post-Nuss for PE repair compared to cases without cryoablation or with cryoablation only. Cryoablation with regional nerve blocks should be considered for Nuss repair under the enhanced recovery after surgery pathway.
METHODS: We conducted a retrospective cohort study at a single center for PE patients who underwent the Nuss procedure from 2017 to 2022. Outcomes included postoperative opioid use (measured in oral morphine milligram equivalent per kilogram [OME/kg]), average pain score (scale 0-10), and length of stay (LOS).
RESULTS: One hundred sixty-four patients (146 males and 18 females) were included, with 79 (48.2%) receiving neither cryoablation nor nerve block, 60 (36.6%) receiving intraoperative cryoablation alone, and 25 (15.2%) receiving both cryoablation and nerve block. The median age was 16 y. Nerve block recipients consumed fewer opioids during hospitalization than cryoablation alone and nonintervention groups (1.5 versus 2.3 versus 5.8 OME/kg, respectively, P < 0.0001). Average pain scores over the total LOS were lower in nerve block recipients (3.5 versus 3.8 versus 4.2, P = 0.03), particularly on postoperative day 0 (P = 0.002). Nerve block recipients had a shorter LOS than cryoablation alone and nonintervention groups (43.4 versus 54.7 versus 66.2 h, P < 0.0001). On multivariate analysis, cryoablation alone resulted in significantly less opioid use compared to no intervention (3.32 OME/kg reduction, 95% confidence interval -4.16 to -2.47, P < 0.0001). Addition of nerve block further reduced opioid use by 1.10 OME/kg (95% confidence interval -2.07 to -0.14, P = 0.04).
CONCLUSIONS: Cryoablation with nerve block supplementation is associated with reduced pain, opioid use, and LOS post-Nuss for PE repair compared to cases without cryoablation or with cryoablation only. Cryoablation with regional nerve blocks should be considered for Nuss repair under the enhanced recovery after surgery pathway.
摘要：
背景：我们的研究评估了冷冻消融，有或没有神经阻滞补充，Nuss手术后疼痛,和阿片类药物在漏斗胸（PE）患者中的使用。
方法：我们在2017年至2022年接受Nuss手术的PE患者的单中心进行了一项回顾性队列研究。结果包括术后阿片类药物的使用（以口服吗啡毫克当量/千克[OME/kg]为单位），平均疼痛评分（0-10分），和停留时间（LOS）。
结果：纳入了164例患者（男性146例，女性18例），79人（48.2%）既未接受冷冻消融也未接受神经阻滞，60例（36.6%）单独接受术中冷冻消融术，25例（15.2%）接受冷冻消融和神经阻滞。中位年龄为16岁。神经传导阻滞接受者在住院期间消耗的阿片类药物少于单独冷冻消融和非干预组(1.5对2.3对5.8OME/kg,分别,P<0.0001)。神经阻滞受者总LOS的平均疼痛评分较低（3.5对3.8对4.2，P=0.03），特别是在术后第0天（P=0.002）。神经传导阻滞接受者的LOS比单独冷冻消融和非干预组的LOS短(43.4h对54.7h对66.2h,P<0.0001)。在多变量分析中，与无干预相比，单独冷冻消融可显著减少阿片类药物的使用（减少3.32OME/kg，95%置信区间-4.16至-2.47，P<0.0001)。添加神经阻滞进一步减少了1.10OME/kg（95％置信区间-2.07至-0.14，P=0.04）。
结论：补充神经阻滞的冷冻消融术可以减轻疼痛，阿片类药物的使用，与未进行冷冻消融或仅进行冷冻消融的情况相比，Nuss后用于PE修复的LOS。Nuss修复应考虑采用局部神经阻滞的冷冻消融术在术后增强恢复路径下进行。
方法：我们在2017年至2022年接受Nuss手术的PE患者的单中心进行了一项回顾性队列研究。结果包括术后阿片类药物的使用（以口服吗啡毫克当量/千克[OME/kg]为单位），平均疼痛评分（0-10分），和停留时间（LOS）。
结果：纳入了164例患者（男性146例，女性18例），79人（48.2%）既未接受冷冻消融也未接受神经阻滞，60例（36.6%）单独接受术中冷冻消融术，25例（15.2%）接受冷冻消融和神经阻滞。中位年龄为16岁。神经传导阻滞接受者在住院期间消耗的阿片类药物少于单独冷冻消融和非干预组(1.5对2.3对5.8OME/kg,分别,P<0.0001)。神经阻滞受者总LOS的平均疼痛评分较低（3.5对3.8对4.2，P=0.03），特别是在术后第0天（P=0.002）。神经传导阻滞接受者的LOS比单独冷冻消融和非干预组的LOS短(43.4h对54.7h对66.2h,P<0.0001)。在多变量分析中，与无干预相比，单独冷冻消融可显著减少阿片类药物的使用（减少3.32OME/kg，95%置信区间-4.16至-2.47，P<0.0001)。添加神经阻滞进一步减少了1.10OME/kg（95％置信区间-2.07至-0.14，P=0.04）。
结论：补充神经阻滞的冷冻消融术可以减轻疼痛，阿片类药物的使用，与未进行冷冻消融或仅进行冷冻消融的情况相比，Nuss后用于PE修复的LOS。Nuss修复应考虑采用局部神经阻滞的冷冻消融术在术后增强恢复路径下进行。
