Abstract
Intercostal nerve cryoablation (INC) during minimally invasive repair of pectus excavatum (MIRPE) reduces postoperative opioid use and hospital length of stay. However, few studies have directly evaluated optimal duration of cryoprobe application. This study compared postoperative outcomes following one-minute versus two-minute INC during MIRPE.
A single-center retrospective study was conducted on patients ≤21 years old who underwent MIRPE with INC between 2023 and 2025. Cryoablation was performed thoracoscopically for either 2 minutes per nerve using the cryoICE® cryoSPHERE+® or 1 minute per nerve using the cryoICE® cryoSPHERE® MAX probe. Demographics, operative characteristics, and postoperative outcomes were compared between groups.
Among 164 patients, 87 (53%) received 2-minutes of INC and 77 (47%) received 1-minute of INC. Patient age, sex, BMI, and Haller Index were similar between groups. Correction Index was greater in the 2-minute group (38% vs 32%, p = 0.005). Operative time was significantly shorter in the 1-minute INC group (137 vs 170 minutes, p < 0.001). Average inpatient pain scores were slightly higher in the 1-minute INC group (3.5 vs 3.1, p < 0.05), but inpatient opioid usage was similar (0.203 vs 0.178 OME/kg). Total opioid prescriptions at discharge were lower (p<0.001) with no difference in opioid refill rates, thirty-day emergency department visits, and readmissions compared to the 2-minute INC group.
Reducing INC duration from two minutes to one minute during MIRPE does not adversely affect postoperative analgesic outcomes and significantly shortens operative time. One-minute intercostal nerve cryoablation appears to provide effective analgesia.