• Seyed A Arshad, Elisa I Garcia, Cynthia Bell, AvritscherElenir B CEBCMcGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX.Children's Memorial Hermann Hospital, Houston, TX., Mohineesh Kumar, Pavan Brahmamdam, James A Fraser, Shawn D St Peter, Arturo Aranda, Madelyn Hill, John Marquart, Kyle Van Arendonk, Leah Plumblee, Christian J Streck, Irving J Zamora, Muhammad O A Ghani, Kirk W Reichard, Karen Sacks, Michelle Kallis, Andrew Hong, Holden Richards, Saunders Lin, Erica R Gross, Mustafa H Kabeer, Troy Reyna, Elizabeth A Paton, Lauren B Camp, Krista Stephenson, Melvin Dassinger, Kaveh Vali, Radu Filipescu, Daniel A DeUgarte, Vikram Krishna, Bethany Slater, Saleem Islam, Grace Thompson, James T Moore, Brian R Englum, Stefan Scholz, Elizabeth Sharbaugh, Jeffrey W Gander, KuoJen Tsao, and Pediatric Surgery Research Collaborative (PedSRC).
• McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX.
• Ann. Surg. 2023 Jun 1; 277 (6): e1373e1379e1373-e1379.

ObjectiveTo assess the clinical implications of cryoanalgesia for pain management in children undergoing minimally invasive repair of pectus excavatum (MIRPE).BackgroundMIRPE entails significant pain management challenges, often requiring high postoperative opioid use. Cryoanalgesia, which blocks pain signals by temporarily ablating intercostal nerves, has been recently utilized as an analgesic adjunct. We hypothesized that the use of cryoanalgesia during MIRPE would decrease postoperative opioid use and length of stay (LOS).Materials And MethodsA multicenter retrospective cohort study of 20 US children's hospitals was conducted of children (age below 18 years) undergoing MIRPE from January 1, 2014, to August 1, 2019. Differences in total postoperative, inpatient, oral morphine equivalents per kilogram, and 30-day LOS between patients who received cryoanalgesia versus those who did not were assessed using bivariate and multivariable analysis. P value <0.05 is considered significant.ResultsOf 898 patients, 136 (15%) received cryoanalgesia. Groups were similar by age, sex, body mass index, comorbidities, and Haller index. Receipt of cryoanalgesia was associated with lower oral morphine equivalents per kilogram (risk ratio=0.43, 95% confidence interval: 0.33-0.57) and a shorter LOS (risk ratio=0.66, 95% confidence interval: 0.50-0.87). Complications were similar between groups (29.8% vs 22.1, P =0.07), including a similar rate of emergency department visit, readmission, and/or reoperation.ConclusionsUse of cryoanalgesia during MIRPE appears to be effective in lowering postoperative opioid requirements and LOS without increasing complication rates. With the exception of preoperative gabapentin, other adjuncts appear to increase and/or be ineffective at reducing opioid utilization. Cryoanalgesia should be considered for patients undergoing this surgery.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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