Cryoablation and Pain Management in Pectus Excavatum
If your child has pectus excavatum, a bone abnormality where the chest appears sunken, you've probably spent a good deal of time weighing the necessity of surgery for them in early adolescence.
Boys Town is now offering a new pain management technique called cryoablation, which can be done at the same time as the Nuss procedure and can greatly reduce the need for opioid pain medicine following the often-painful surgery.
Background on Pectus Excavatum
The Boys Town Pectus Clinic sees 50-100 new cases of pectus excavatum each year. Pectus excavatum requires surgery in severe cases to avoid compression of vital organs like the heart and lungs.
Not all patients need surgery, but those that do will have the Nuss procedure to insert corrective bars into the ribs to alleviate pectus excavatum. Despite being a minimally invasive surgery, it has historically been a very painful surgery and recovery. (You could compare it to the pain of tightening braces, except it involves the rib cage, not teeth, and the movement happens all at once.)
the Need for Opioids
That's why Boys Town Pediatric General and Thoracic Surgery has added the option for the latest technology in cryoablation to the Nuss procedure.
Key Benefits of Cryoablation:
- Decreased length of post-surgical hospital stay
- Reduced need for opioid pain management
Since opioid addiction often starts with a medical or surgical procedure that causes pain, this non-opioid option (which offers long-term pain relief) could be a key decision-making point as you decide whether your child should have surgery.
Surgeons at Boys Town have seen their patients use much lower doses of opioids and for about half the usual length of time with the cryoablation procedure. There have even been several patients who did not require any opioids at all post-surgery.
How Cryoablation Works
Both the Nuss procedure and cryoablation are performed thoracoscopically. A thoracoscope is a thin, flexible tube with a small video camera and a light attached to the end. This method keeps both procedures minimally invasive.
Cryoablation provides a full nerve block starting six to 12 hours after the procedure. So, the anesthetists perform a regional nerve block before the operation begins. The regional block takes care of the pain for the first six to 12 hours as the cryoablation takes effect and blocks the pain.
Using the thoracoscope, several rib spaces are identified and each nerve is frozen, at negative 80 degrees, for two minutes. Usually, cryoablation is performed on 4 rib spaces on each side. The nerves will regenerate over three to six months.
Cryoablation adds 30 to 45 minutes to the length of the pectus excavatum surgery. However, the shorter hospital stays and the dramatically reduced need for opioid pain medications outweigh the extra time in the surgical suite.