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Intercostal nerve cryoablation reduces length of stay by 2.2 days in pediatric pectus excavatum surgery compared to standard careIce on nerves shortens hospital stays for chest wall surgery in children

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Key Takeaway
Consider intercostal nerve cryoablation to reduce length of stay in pediatric pectus excavatum repair.

This systematic review and meta-analysis examined the impact of intercostal nerve cryoablation (INC) compared to standard multimodal analgesia (MMA), with or without thoracic epidural, in pediatric patients undergoing pectus excavatum repair. The analysis included 922 patients across the included studies. The primary outcome was length of stay (LOS), while secondary outcomes included opioid consumption, postoperative pain, complications, operative time, and hospitalization costs.

The pooled results indicated that INC reduced LOS by 2.2 days (95% CI: -2.8 to -1.8). Conversely, operating room time increased by 23 minutes (95% CI: 10-39). Opioid use was reduced, though specific effect sizes were not reported. Pain scores were comparable between groups, and complication rates were also comparable. The impact on hospitalization costs was conflicting.

Safety data regarding adverse events, serious adverse events, discontinuations, and tolerability were not reported. The authors highlight that further studies are needed to assess long-term safety and cost-effectiveness. Funding sources and conflicts of interest were not reported. The certainty of evidence regarding long-term outcomes remains uncertain due to these limitations.

Chest wall surgery can be scary for kids. The pain after the operation often means longer hospital stays and more time on strong pain medicine. A new look at data from 922 pediatric patients offers a different path. Doctors used ice applied to the nerves around the ribs to block pain signals. They compared this method to standard pain control, which might include numbing medicine around the spine.

The results were clear. Children who got the ice treatment left the hospital two days sooner on average. Their pain scores were just as good as those who received standard care. They also used less opioid medicine. The time spent in the operating room was a bit longer, but the overall recovery seemed faster.

Safety looked good in the short term. Complication rates were similar between the two groups. However, experts say we need more time to see if this approach stays safe and saves money over the long haul. For now, this method offers a promising way to help children recover faster after chest surgery.

What this means for you:
Ice on chest nerves helps children leave the hospital two days sooner after chest wall surgery.

Study Details

Study typeMeta analysis
Sample sizen = 922
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
INTRODUCTION: Nuss procedure is the standard technique for pectus excavatum repair. Despite its minimally invasive nature, this procedure is associated with significant postoperative pain and high opioid consumption. Intercostal nerve cryoablation (INC) has emerged as an adjunct to multimodal analgesia (MMA) to improve pain control, reduce opioid use, and shorten length of stay (LOS). This systematic review aims to assess INC outcomes following the Nuss procedure in pediatric patients. MATERIALS AND METHODS: A systematic search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library databases through December 2024. Studies comparing INC with standard MMA, with or without thoracic epidural, in pediatric patients undergoing the Nuss procedure were included. The primary outcome was LOS, and the secondary outcomes were opioid consumption, postoperative pain, complications, operative time, and hospitalization costs. Risk of bias was determined using the National Institutes of Health assessment tool. Meta-analysis was performed using R software. RESULTS: Eleven studies met the inclusion criteria, comprising 922 patients (476 INC and 446 control). INC significantly reduced LOS (-2.2 days; 95% CI: -2.8 to -1.8) at the expense of increased operating room time (+23 minutes; 95% CI: 10-39). Qualitative analysis showed reduced opioid use and comparable pain scores and complication rates with INC, while its impact on costs was conflicting. CONCLUSION: INC reduces LOS and opioid use in pediatric patients undergoing the Nuss procedure without increasing complications. Further studies are needed to assess long-term safety and cost-effectiveness.
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