The use of pre-emptive percutaneous cryoanalgesia beforemodified Ravitch funnel chest surgery – a new form ofpostoperative pain management. A report of two clinical cases

Abstract

Pectus excavatum (PE) is the most common congenital deformity of the anterior chest wall, with an estimatedincidence of 1 in 400–1000 births. It typically manifests in the neonatal period but can also appear duringadolescence. Clinical symptoms may arise from compression of the lungs and heart. The standard treatment forPE is surgical intervention. The modified Ravitch procedure is an invasive correction method used to treat pectusexcavatum. This procedure is associated with significant postoperative pain, often exceeding 5 on the numericalrating scale (NRS), which can be difficult to manage with conventional methods such as patient-controlled analgesia(PCA) or continuous thoracic epidural analgesia (cTE). A new alternative adjunct therapy for managing acutepain after thoracic surgery is peripheral nerves cryoablation – a procedure involving temporary blockade of nerveconduction in the intercostal nerves using a narrow range of low temperatures, optimally performed before thesurgical procedure. This results in long-lasting analgesia that allows for a reduction of opioid requirements or evencomplete discontinuation. This paper presents two cases of pediatric patients who, due to invasive thoracic surgicalprocedures, underwent intercostal percutaneous cryoablation (IPC) before the surgery. Performing preemptivepercutaneous intercostal nerve cryoablation reduced opioid intake and allowed for shorter hospital stay, as well assignificantly increased comfort of our patients. The description of these two cases aims to highlight the preemptivecryoablation as a potential, potent, alternative analgesia method adjunct to pharmacotherapy of pain in patientsundergoing extensive thoracic surgical procedures.