P2D382: Nationwide Comparison of Epidural Analgesia versus Intercostal Nerve Cryoablation in Pectus Repair

Background: Pectus excavatum is the most common chest wall deformity and often requires operative repair during adolescence. In recent years, intercostal nerve cryoablation has emerged as a strategy for postoperative analgesia. We hypothesized that cryoablation was associated with less pain and fewer complications than epidural/regional analgesia.

Methods: The Nationwide Readmissions Database from 2016 to 2020 was used to identify patients ≥12 years of age who underwent surgery for pectus excavatum. Patients were stratified by analgesic modality (epidural/regional versus cryoablation), and those without documented pain management strategy were excluded. Demographics, complications, readmissions, utilization, and outcomes were compared using standard statistical tests.

Results: Among 1,038 total patients (median age 15 [14-17] years, 86% male), the majority received epidural analgesia (n=648, 63%) rather than cryoablation (n=381, 37%). From 2016-2020 there was a gradual increase in cryoablation utilization as a therapeutic modality (Figure 1). Cryoablation was associated with less postoperative acute pain (11% vs. 19%), fewer opioid-related complications (3% vs. 8%), and fewer respiratory complications (6% vs. 10%) than epidural anesthesia, Table 1. There was no difference in the rates of postoperative bleeding, chest tube insertion, pleural effusion, or pneumothorax between analgesic strategies. Patients receiving cryoablation had shorter lengths of stay, though costs were higher. Readmission rates were equivalent.

Conclusion: This analysis of a large nationwide sample shows that intercostal nerve cryoablation during pectus repair is associated with superior pain control, fewer complications, and a shorter length of stay than epidural/regional analgesia. While costs are slightly higher with cryoablation, it is a promising analgesic technique that is growing in popularity in the United States.