{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:41:14Z","timestamp":1787316074326,"version":"build-2736575974"},"reference-count":10,"publisher":"Georg Thieme Verlag KG","issue":"06","license":[{"start":{"date-parts":[[2024,1,19]],"date-time":"2024-01-19T00:00:00Z","timestamp":1705622400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr Surg"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Background\u2003Nuss procedure for pectus excavatum is a minimally invasive, but painful procedure. Recently, intercostal nerve cryoablation has been introduced as a pain management technique.<\/jats:p>\n                  <jats:p>Materials and Methods\u2003In this cohort study, we compared the efficacy of multimodal pain management strategies in children undergoing a Nuss procedure. The effectiveness of intercostal nerve cryoablation combined with patient-controlled systemic opioid analgesia (PCA) was compared with continuous epidural analgesia (CEA) combined with PCA. The study was conducted between January 2019 and July 2022. Primary outcome was length of stay (LOS), and secondary outcomes were operation room time, postoperative pain, opioid consumption, and gabapentin use.<\/jats:p>\n                  <jats:p>Results\u2003Sixty-six consecutive patients were included, 33 patients in each group. The cryoablation group exhibited lower Numeric Rating Scale (NRS) pain scores on postoperative day 1 and 2 (p\u2009=\u20090.002, p\u2009=\u20090.001) and a shorter LOS (3 vs. 6 days (p\u2009&lt;\u20090.001). Cryoablation resulted in less patients requiring opioids at discharge (30.3 vs. 97.0%; p\u2009&lt;\u20090.001) and 1 week after surgery (6.1 vs. 45.4%; p\u2009&lt;\u20090.001)). In the CEA group, gabapentin use was more prevalent (78.8 vs. 18.2%; p\u2009&lt;\u20090.001) and the operation room time was shorter (119.4 vs. 135.0\u2009minutes; p\u2009&lt;\u2009.010). No neuropathic pain was reported.<\/jats:p>\n                  <jats:p>Conclusions\u2003Intercostal nerve cryoablation is a superior analgesic method compared with CEA, with reduced LOS, opioid use, and NRS pain scores. The prophylactic use of gabapentin is redundant.<\/jats:p>","DOI":"10.1055\/a-2249-7588","type":"journal-article","created":{"date-parts":[[2024,1,19]],"date-time":"2024-01-19T19:01:46Z","timestamp":1705690906000},"page":"488-492","source":"Crossref","is-referenced-by-count":7,"title":["Intercostal Nerve Cryoablation or Epidural Analgesia for Multimodal Pain Management after the Nuss Procedure: A Cohort Study"],"prefix":"10.1055","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6555-427X","authenticated-orcid":false,"given":"Hendrik","family":"van Braak","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, AZ, Amsterdam, Noord-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sjoerd A.","family":"de Beer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, AZ, Amsterdam, Noord-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin R.","family":"de Jong","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, AZ, Amsterdam, Noord-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus F.","family":"Stevens","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gijsbert","family":"Musters","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery and Surgical Oncology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sander","family":"Zwaveling","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, AZ, Amsterdam, Noord-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthijs W. N.","family":"Oomen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, AZ, Amsterdam, Noord-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendeline Van","family":"der Made","sequence":"additional","affiliation":[{"name":"Department of Surgery, Leiden Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Egbert","family":"Krug","sequence":"additional","affiliation":[{"name":"Department of Surgery, Leiden Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.W. Ernest","family":"van Heurn","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, AZ, Amsterdam, Noord-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,2,16]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"e0232575","DOI":"10.1371\/journal.pone.0232575","article-title":"Prevalence of pectus excavatum in an adult population-based cohort estimated from radiographic indices of chest wall shape","volume":"15","author":"M Biavati","year":"2020","journal-title":"PLoS One"},{"issue":"11","key":"ref2","doi-asserted-by":"crossref","first-page":"2250","DOI":"10.1016\/j.jpedsurg.2019.02.057","article-title":"Intraoperative intercostal nerve cryoablation During the Nuss procedure reduces length of stay and opioid requirement: a randomized clinical trial","volume":"54","author":"C E Graves","year":"2019","journal-title":"J Pediatr Surg"},{"issue":"12","key":"ref3","doi-asserted-by":"crossref","first-page":"2229","DOI":"10.1016\/j.jpedsurg.2021.03.006","article-title":"Intercostal cryoablation during Nuss procedure: a large volume single surgeon's experience and outcomes","volume":"56","author":"R C Sun","year":"2021","journal-title":"J Pediatr Surg"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1093\/icvts\/ivaa151","article-title":"Intercostal nerve cryoablation versus thoracic epidural for postoperative analgesia following pectus excavatum repair: a systematic review and meta-analysis","volume":"31","author":"J HT Daemen","year":"2020","journal-title":"Interact Cardiovasc Thorac Surg"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1016\/j.jpedsurg.2022.12.011","article-title":"Cost and outcomes of intercostal nerve cryoablation versus thoracic epidural following the Nuss procedure","volume":"58","author":"R A Perez Holguin","year":"2023","journal-title":"J Pediatr Surg"},{"issue":"12","key":"ref6","doi-asserted-by":"crossref","first-page":"2033","DOI":"10.1016\/j.jpedsurg.2016.09.034","article-title":"Intercostal nerve cryoablation versus thoracic epidural catheters for postoperative analgesia following pectus excavatum repair: preliminary outcomes in twenty-six cryoablation patients","volume":"51","author":"B A Keller","year":"2016","journal-title":"J Pediatr Surg"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.jss.2018.05.048","article-title":"Comparing outcomes with thoracic epidural and intercostal nerve cryoablation after Nuss procedure","volume":"231","author":"C M Harbaugh","year":"2018","journal-title":"J Surg Res"},{"issue":"10","key":"ref8","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1016\/j.jpedsurg.2020.10.009","article-title":"Intercostal nerve cryoablation is associated with lower hospital cost during minimally invasive Nuss procedure for pectus excavatum","volume":"56","author":"T J Aiken","year":"2021","journal-title":"J Pediatr Surg"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/s00383-023-05429-7","article-title":"A pilot study of multi-modal pain management for same-day discharge after minimally invasive repair of pectus excavatum (Nuss procedure) in children","volume":"39","author":"S Akinboro","year":"2023","journal-title":"Pediatr Surg Int"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1007\/s00383-019-04602-1","article-title":"The incidence of neuropathic pain after intercostal cryoablation during the Nuss procedure","volume":"36","author":"M J Zobel","year":"2020","journal-title":"Pediatr Surg Int"}],"container-title":["European Journal of Pediatric Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2249-7588.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T18:34:33Z","timestamp":1730831673000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2249-7588"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,19]]},"references-count":10,"journal-issue":{"issue":"06","published-online":{"date-parts":[[2024,11,5]]},"published-print":{"date-parts":[[2024,12]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2249-7588","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0939-7248","1439-359X"],"issn-type":[{"value":"0939-7248","type":"print"},{"value":"1439-359X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,1,19]]},"published":{"date-parts":[[2024,1,19]]}}}