Intercostal Nerve Cryoablation During Pectus Excavatum Surgery for Postoperative Pain Management: A Systematic Review and Meta-Analysis
Abstract
OBJECTIVE
The objective of this study was to systematically review the literature-reported outcomes of CRYO compared to standard of care without CRYO (non-CRYO) after PEx repair.
SUMMARY BACKGROUND DATA
Surgical repair of pectus excavatum (PEx) via the Nuss or Ravitch procedures is associated with substantial postoperative pain. Intercostal nerve cryoablation (CRYO) performed during the primary surgical repair has been adopted as a non-opioid modality for pain management.
METHODS
A literature search was conducted in PubMed, Embase, and using additional online approaches to identify comparative studies of patients undergoing the Nuss or Ravitch procedure for PEx repair with CRYO versus non-CRYO between years 2014-24. Meta-analysis was performed to quantitatively evaluate primary outcomes of hospital length of stay (LOS) and opioid consumption. Secondary outcomes were hospital costs and complications, summarized qualitatively.
RESULTS
Of 178 studies, 32 comparative studies encompassing 13,103 patients were included; 28% (n=3,620) received CRYO. Random effects meta-analyses demonstrated a significantly shortened LOS by 1.8 days (95% confidence interval [CI]: -2.12, -1.42) and a significant reduction in inpatient and outpatient opioid consumption with CRYO by 186 morphine mg equivalents (MME) (95% CI: -262.26, -109.08) and 147 MME (95% CI: -255.72, -38.26), respectively. Complications with CRYO were either decreased or similar between groups and resolved over time. Hospital…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 13,103 participants or records.
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