Impact of timing of intercostal nerve cryoablation on postoperative opioid use and outcomes in MIRPE.

Abstract

Introduction: To determine if the intraoperative timing of intercostal nerve cryoablation (INC) during minimally invasive repair of pectus excavatum (MIRPE) impacts postoperative opioid use or outcomes.

Methods: A single-center, retrospective cohort study of patients aged ≤ 21 years who underwent MIRPE with INC from 2023 to 2025 was evaluated. Patients were stratified by timing of INC during their MIRPE operation: INC before bar placement versus INC after bar placement. Patient demographics, operative details, opioid use, and postoperative outcomes were collected.

Results: A total of 151 patients who underwent MIRPE with INC were analyzed. Of these, 41 (27%) underwent INC before bar placement while 110 (73%) underwent INC after bar placement. The two groups were similar in age, weight, gender, BMI, and pectus severity. There was no statistically significant difference in inpatient opioid use (in oral morphine equivalents (OME)) (0.20 vs 0.19 OME/kg/day, p = 0.751) or discharge opioid use (1.02 vs 1.19 OME/kg, p = 0.148). On multivariable analysis adjusting for regional nerve block use, number of bars, and intercostal levels treated, neither cryoablation timing nor regional nerve block use was independently associated with inpatient opioid consumption (p = 0.577 and p = 0.775, respectively). Hospital length of stay, emergency department visits within 30 days, and 30-day readmissions were comparable between the two cohorts.

Conclusion: INC was most often performed after bar placement during MIRPE in this cohort. The timing of intercostal nerve cryoablation relative to bar placement does not significantly impact opioid use or postoperative outcomes, suggesting timing of INC can be left up to surgeon discretion.