Highlights
- •Cryoablation can be safely performed extra-thoracically during cartilaginous rib excision for slipping rib syndrome.
- •Cryoablation decreases opioid use and hospital length of stay following cartilaginous rib excision.
- •Ablation to T9 and/or T10 extra-thoracically does not lead to abdominal wall laxity.
Abstract
Introduction
Minimally invasive repair of pectus excavatum (MIRPE) and cartilaginous rib excision
(CRE) for slipping rib syndrome (SRS) are painful procedures. Intercostal nerve cryoablation
(Cryo) controls pain and decreases opioid use in MIRPE. Herein, we describe our experience
with cryoablation in CRE.
Methods
A retrospective chart review was performed of all patients undergoing CRE between
2018 and 2022. Data on demographics, clinical characteristics, operative details,
and hospital course were collected.
Results
A total of 98 patients underwent CRE: 68 CRE without cryo, 22 CRE+Cryo, and 8 combined
MIRPE+CRE+Cryo. Ninety percent of patients underwent bioabsorbable rib plating. Patients
were predominantly female (79%, 73%, 50% respectively) with median ages 17.6, 16.9,
and 14.2 years respectively. CRE+Cryo patients used significantly less opioids in
hospital (0.6 OME/kg [0.1,1.2]) compared to CRE without cryo (1.0 OME/kg [0.6,2.1]),
p<0.05. The median length of stay (LOS) in CRE+Cryo was 1 day [
[1]
,
[2]
] compared to 2 days in CRE without cryo [
[1]
,
[2]
], p=0.09. MIRPE+CRE+Cryo patients used 0.6 OME/kg [0.2,8.0] with a 2 day [1,5.5]
LOS. Ninety-one percent of Cryo patients had cryoablation of T9 and/or T10 intercostal
nerves, with no documented abdominal wall laxity at median follow-up of 16 days. Cryo
was applied extra-thoracically in CRE+cryo without thoracoscopy or lung isolation,
while MIRPE+CRE+Cryo used a combination extra-/intra-thoracic cryoablation in with
thoracoscopy.Conclusion
Intercostal nerve cryoablation reduces opioid use and LOS in patients undergoing cartilaginous
rib excision for slipping rib syndrome. Cryotherapy to as low as T10 did not result
in abdominal wall laxity and can be applied extra-thoracically without the need for
thoracoscopy. Ongoing prospective studies are required to assess the long-term outcomes.
Level of evidence
III.
Keywords
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Article info
Publication history
Accepted:
December 29,
2022
Received in revised form:
December 16,
2022
Received:
June 24,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
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