Is cryoanalgesia superior to thoracic epidural analgesia for postoperative recovery after the nuss procedure? An updated meta-analysis.

BACKGROUND

The Nuss procedure is commonly used to correct pectus excavatum, with cryoanalgesia (CA) and thoracic epidural analgesia (TEA) as pain management options. While a prior meta-analysis showed shorter hospital stays with CA, publication of recent studies warrants a more comprehensive evaluation of outcomes not previously reported.

METHODS

A literature search identified studies comparing CA and TEA in Nuss procedures. Pooled odds ratios, mean differences (MDs), and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using RevMan 8.13.0, with a subgroup analysis of randomized and propensity matched studies.

RESULTS

Fifteen studies were included, comprising 1,391 patients, of whom 823 (62.4%) received CA. CA was associated with a longer operative duration (MD 29.1 minutes, 95% CI 17.3 to 40.8; P < 0.001) and increased hospitalisation costs (MD 1,655.3 US dollars, 95% CI 1,154.1 to 2,156.5; P < 0.001), but conferred benefits such as a reduced hospital stay (MD -2.7 days, 95% CI -3.1 to -2.4; P < 0.001), lower postoperative pain on postoperative day 3 (SMD -0.6, 95% CI -0.9 to -0.3; P < 0.001), and decreased opioid consumption (MD -253.7 morphine milligram equivalent, 95% CI -336.6 to -170.8; P < 0.001). The subgroup analysis corroborated these findings, demonstrating shorter hospital stay with no differences in complication rates.

CONCLUSIONS

Consistent with the prior meta-analysis, the authors' updated meta-analysis indicates that CA is associated with reduced hospital stay. Additionally, their analysis revealed that CA lowers postoperative pain and opioid consumption, however, the increased costs necessitate a cost-benefit evaluation.