Evolution of Pain Control for Adult Pectus Excavatum Repair

BACKGROUND Pain control after minimally invasive repair of pectus excavatum (MIRPE) can be challenging especially in adult patients undergoing surgical repair. This study reviewed different analgesic modalities utilized over ≥ 10 years after pectus repair. METHODS A retrospective analysis was performed of adult patients (≥18 years) who underwent uncomplicated primary MIRPE at a single institution from October 2010-December 2021. Patients were classified by analgesic modality utilized: Epidural; Elastomeric Continuous Infusion Subcutaneous Catheters (SC-Cath); and Intercostal Nerve Cryoablation. Comparisons among the 3 groups were performed. RESULTS In total, 729 patients were included (mean age 30.9 ±10.3 years, 67% males, mean Haller Index 4.9 ±3.0. Patients in the Cryoablation group required significantly lower doses of morphine equivalents (p<0.001) and had overall the shortest hospital stay (mean 1.9 ±1.5 days, p<0.001) with <17% staying >2 days (versus epidural 94% and SC-Cath 48%, p<0.001). The Cryoablation group had a lower incidence of ileus and constipation (p<0.001) but a higher incidence of pleural effusion requiring thoracentesis (p=0.024). Mean pain scores between groups were minor (<3) and differences insignificant. CONCLUSIONS The use of Cryoablation in conjunction with enhanced recovery pathways provided significant benefit to our MIRPE patients compared to prior analgesic modalities. These benefits included a decrease in length of hospital stay, a reduction of in-hospital opioid use, and a lower incidence of opioid related complications associated with constipation and ileus. Further studies to assess additional potential benefits with long term follow-up after discharge warrants further investigations.