Thoracoscopic intercostal nerve thermal radiofrequency ablation for postoperative pain relief following the Nuss procedure.

BACKGROUND

The Nuss procedure for pectus excavatum causes significant postoperative pain due to forceful correction of the sternum and ribs. Intercostal cryoablation (ICA) has shown efficacy but is limited in Japan due to insurance restrictions. This study evaluates the efficacy and safety of thoracoscopic intercostal nerve thermal radiofrequency ablation (INTRA) as an alternative postoperative analgesic approach.

METHODS

A retrospective review was conducted on 170 consecutive patients who underwent the Nuss procedure with INTRA at Nishinomiya Watanabe Cardiovascular Center between May 2022 and December 2024. INTRA was performed using a radiofrequency generator and pole needles at 70 °C for 60 s. Under thoracoscopic guidance, the needles penetrated the chest wall, and ablation targeted the main intercostal nerve trunk and lateral branches. Postoperative pain control, complications, and outcomes were analyzed.

RESULTS

The median age was 17 years (range: 12-66); 139 were male and 31 female. The mean operative time, including INTRA, was 104.8 ± 33.3 min. No procedure-related complications occurred except for minor intercostal hematomas, which resolved spontaneously. No chest tube was required for postoperative pleural effusion. Neither opioids nor epidural analgesia were needed, and 75.9 % of patients ambulated independently by postoperative day one. Among 138 patients with >6 months of follow-up, 8 % reported mild paresthesia, while the remainder had normal skin sensation. No neuropathic pain was observed.

CONCLUSION

INTRA is a safe and effective method for postoperative pain control in Nuss procedure patients, enabling early mobilization without opioids or epidural anesthesia. Comparative studies with ICA are warranted.