Feeling the difference: Long-term sensory outcomes following the minimally invasive repair of pectus excavatum with and without intercostal nerve cryoablation: A multicenter prospective observation study.

INTRODUCTION

Intercostal nerve cryoablation (INC) during the minimally invasive repair of pectus excavatum (MIRPE) provides effective post-operative analgesia; long-term neurosensory effects of MIRPE/INC remain unclear. The study aimed to compare chest wall sensation at pectus-bar removal in patients who previously had MIRPE with and without INC.

METHODS

We conducted a multi-institutional prospective study of patients ≤21 who underwent MIRPE with and without INC between 1/11/2021-8/18/2024. Chest wall sensory testing was performed pre-bar removal, and at 2 weeks and 2 months post-bar removal. Demographics and operative details of MIRPE were reviewed. Chest wall hypoesthesia to stimulation were compared between groups.

RESULTS

166 participants were enrolled (male - 86 %, mean age - 18.3 ± 1.7 years at bar removal, median duration of bar implantation - 3.0 [IQR:2.9-3.1] years) INC was performed in 78 % (n = 130) during MIRPE. Compared to no-INC, INC patients were more likely to have >1 pectus bar (82 % vs 47 %, p < 0.001) and pericostal suture fixation (85 % vs 44 %, p = 0.004). Prior to bar removal, chest wall hypoesthesia in ≥1 dermatome was found in 58 % of INC vs 50 % of no-INC (p = 0.451). At two month follow up 85 % of patients had normal chest wall sensation (85 % INC vs 95 % no-INC, p = 0.460). Hypoesthesia was associated with >1 pectus bar implanted.

CONCLUSION

Three years following MIRPE, hypoesthesia to 1-2 dermatomes in the region of the pectus bar(s) is present in nearly half of patients and is not associated with intercostal nerve cryoablation. Following bar removal, chest wall sensation is normal in approximately 80 % of all patients.