Time to spare: 1-Minute vs 2-minute intercostal nerve cryoablation during minimally invasive repair of pectus excavatum.

BACKGROUND

Intercostal nerve cryoablation (INC) during minimally invasive repair of pectus excavatum (MIRPE) reduces postoperative opioid use and hospital length of stay. However, few studies have directly evaluated optimal duration of cryoprobe application. This study compared postoperative outcomes following 1-min versus 2-min INC during MIRPE.

METHODS

A single-center retrospective study was conducted on patients ≤21 years old who underwent MIRPE with INC between 2023 and 2025. Cryoablation was performed thoracoscopically for either 2 min per nerve using the cryoICE® cryoSPHERE+® or 1 min per nerve using the cryoICE® cryoSPHERE® MAX probe. Demographics, operative characteristics, and postoperative outcomes were compared between groups.

RESULTS

Among 164 patients, 87 (53%) received 2-min of INC and 77 (47%) received 1-min of INC. Patient age, sex, BMI, and Haller Index were similar between groups. Correction Index was greater in the 2-min group (38% vs 32%, p = 0.005). Operative time was significantly shorter in the 1-min INC group (137 vs 170 min, p < 0.001). Average inpatient pain scores were slightly higher in the 1-min INC group (3.5 vs 3.1, p < 0.05), but inpatient opioid usage was similar (0.203 vs 0.178 OME/kg). Total opioid prescriptions at discharge were lower (p < 0.001) with no difference in opioid refill rates, thirty-day emergency department visits, and readmissions compared to the 2-min INC group.

CONCLUSION

Reducing INC duration from 2 min to 1 min during MIRPE does not adversely affect postoperative analgesic outcomes and significantly shortens operative time. One-minute intercostal nerve cryoablation appears to provide effective analgesia.