Cryoanalgesia Plus Nerve Block Strategies versus Cryoanalgesia Alone in Patients with Pectus Excavatum Undergoing the Nuss Procedure: A Systematic Review and Meta-Analysis.

Cryoanalgesia (CA) has shown promise in managing postoperative pain in patients undergoing the Nuss procedure for pectus excavatum, but has a delayed onset. Adjunctive regional anesthesia, such as nerve blocks (NBs), may enhance early analgesia. Our meta-analysis aims to evaluate the comparative efficacy of combining CA with NB (CNB) versus CA alone.A literature search was conducted focusing on studies that compared CNB and CA alone for postoperative pain management following the Nuss procedure. RevMan 8.13.0 was used to calculate effect estimates reported as mean differences (MDs), with 95% confidence intervals (CIs).Three observational studies comprising a total of 161 patients were included. Of these, 71 patients (44.1%) received the combined treatment of CNB. CNB was associated with significantly shorter hospital stays (MD -0.51 days; 95% CI -0.80 to -0.21; p < 0.05; I 2 = 0%), reduced postoperative opioid consumption (MD -0.74 OME/kg; 95% CI -1.16 to -0.32; p < 0.05; I 2 = 35%), and lower postoperative pain scores on postoperative day (POD) 3 (MD -1.03 points; 95% CI -1.76 to -0.30; p < 0.05; I 2 = 0%). No significant differences were observed in operative duration or postoperative pain scores on POD 0, 1, and 2.CNB may be associated with improved postoperative outcomes compared with CA alone in patients undergoing the Nuss procedure. However, given the small sample size and the observational nature of the included studies, further high-quality randomized controlled trials are needed to validate these findings and inform clinical practice.