317 - No Fuss Nuss: Combined Intercostal Cryoablation and Long Acting Bupivicaine Dual Therapy is Superior to Traditional Pain Managment for Nuss Procedures

Poster Number: 317
Publication Number: 317.444

Andrew C. Herman, Atrium Health Levine Children's Hospital, Charlotte, NC, United States; Thomas M. Schmelzer, Pediatric Surgical Associates, Charlotte, NC, United States; Clay V. Locklear, Levine Children's Hospital, Charlotte, NC, United States

Background: Traditional post-operative pain control for the Nuss procedure for Pectus Excavatum repair is well described and often inadequate. Novel therapies using non-narcotic analgesia reduce opioid exposure and may be superior to traditional strategies.

Objective: This study compares outcomes of bilateral intercostal nerve cryoablation combined with local long-acting bupivacaine with traditional pain control strategies for pediatric patients undergoing the Nuss procedure.

Design/Methods: We performed a retrospective chart review of pediatric patients at Levine Children’s Hospital (LCH) who underwent a Nuss procedure by a single surgeon over a 9-year period (2012-2021). Patients receiving standard pain control methods including thoracic epidural and patient controlled analgesia (PCA) were compared to those who received combined  intercostal nerve cryoablation and local liposomal bupivacaine.  The primary outcome was overall cost adjusted for inflation.  Secondary outcomes included operational and flow metrics: overall length of stay, operating room time, anesthesia time, opioid use and post-operative complications.  Statistics employed were the Wilcoxon rank sum, Chi square and T-test with significance determined at p= 0.05.

Results: We reviewed 63 consecutive Nuss procedures with 44 receiving standard pain control vs. 19 receiving the combined therapy.  Comparing the two groups showed that those receiving combined therapy showed a reduction in length of stay (1.1 vs. 4.2 days, p < 0.001), no use of patient-controlled analgesia and no complications.  The combined group had increased operative (92 vs. 72 minutes , P =001) and total anesthesia time ( 131 vs. 116 minutes, P < 0.05) vs. standard pain control.  Despite increased anesthesia and OR time contributing to overall cost, financial analysis accounting for 3% yearly inflation showed a similar cost between the combined and traditional groups ($68,033 vs. $67,504, p=0.929).  The Combined group also demonstrated a reduction in overall opioid use (Table 1).Conclusion(s): Combined bilateral intercostal nerve cryoablation with long acting-bupivacaine is superior to traditional post-op pain management in patients undergoing a Nuss procedure.  This novel approach allows for reduced narcotic use with improved length of stay, allowing children to return to school faster and reducing indirect cost to the family while providing equivalent direct cost.
Table 1. Nuss Procedure Narcotic UsageAbbreviations: OMME= oral morphine milligram equivalents; SD = standard deviation. * denotes < 0.05 for significance