Intercostal nerve cryoablation reduces length of stay by 2.2 days in pediatric pectus excavatum surgery compared to standard care

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European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie Published June 1, 2026 Medically reviewed June 1, 2026 Study authors: Marques Diogo, Vieira Rafael, Fragoso Ana, Tuna Tiago PubMed ↗ DOI ↗ By Dr. Ji-eun Park, MD · Brain, Mind & Pain

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.

Study Details

Study typeMeta analysis

Sample sizen = 922

EvidenceLevel 1

PublishedJun 2026

PMID40992428

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.