{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T13:00:25Z","timestamp":1792674025594,"version":"4.5.0"},"reference-count":63,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T00:00:00Z","timestamp":1692835200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The minimally invasive repair of pectus excavatum (PE) is a painful procedure that can result in long-term hospitalization and opioid use. To mitigate the length of stay and opioid consumption, many different analgesia strategies have been implemented. The aim of this study is to review the use and patient outcomes of intercostal nerve cryoablation (INC) during PE repair reported in the literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      An unfunded literature search using PubMed identifying articles discussing INC during PE repair from 1946 to 1 July 2023 was performed. Articles were included if they discussed patient outcomes with INC use during PE repair. Articles were excluded if they were reviews\/meta-analyses, editorials, or not available in English. Each article was reviewed for bias by analyzing the study methods, data analysis, patient selection, and patient follow-up. Articles comparing outcomes of INC were considered significant if\n                      <jats:italic>p<\/jats:italic>\n                      -value was &amp;lt;0.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 34 articles were included in this review that described INC use during pectus repair. Most supported a decreased hospital length of stay and opioid use with INC. Overall, INC was associated with fewer short-term and long-term complications. However, the researchers reported varied results of total hospital costs with the use of INC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The review was limited by a paucity of prospective studies and low number of patients who received INC. Despite this, the present data support INC as a safe and effective analgesic strategy during the repair of PE.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2023.1235120","type":"journal-article","created":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T23:31:58Z","timestamp":1692919918000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":32,"title":["Intercostal nerve cryoablation therapy for the repair of pectus excavatum: a systematic review"],"prefix":"10.3389","volume":"10","author":[{"given":"R. Scott","family":"Eldredge","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"McMahon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,8,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","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":"Biavati","year":"2020","journal-title":"PLoS One"},{"key":"B2","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1016\/j.suc.2012.03.001","article-title":"Chest wall deformities in pediatric surgery","volume":"92","author":"Obermeyer","year":"2012","journal-title":"Surg Clin North Am"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.1111\/pan.12988","article-title":"A review of anesthetic techniques and outcomes following minimally invasive repair of pectus excavatum (Nuss procedure)","volume":"26","author":"Frawley","year":"2016","journal-title":"Paediatr Anaesth"},{"key":"B4","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1053\/j.semtcvs.2009.03.001","article-title":"Anatomical, histologic, and genetic characteristics of congenital chest wall deformities","volume":"21","author":"Fokin","year":"2009","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1093\/icvts\/ivs045","article-title":"Pectus excavatum: history, hypotheses and treatment options","volume":"14","author":"Brochhausen","year":"2012","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"493","DOI":"10.21037\/acs.2016.06.04","article-title":"Pectus excavatum from a pediatric surgeon's perspective","volume":"5","author":"Nuss","year":"2016","journal-title":"Ann Cardiothorac Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1016\/j.jpedsurg.2017.05.028","article-title":"Comparison of the Nuss versus Ravitch procedure for pectus excavatum repair: an updated meta-analysis","volume":"52","author":"Mao","year":"2017","journal-title":"J Pediatr Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1016\/j.jamcollsurg.2007.03.027","article-title":"Prospective multicenter study of surgical correction of pectus excavatum: design, perioperative complications, pain, and baseline pulmonary function facilitated by internet-based data collection","volume":"205","author":"Kelly","year":"2007","journal-title":"J Am Coll Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1016\/j.jpedsurg.2014.02.072","article-title":"Epidural analgesia versus intravenous patient-controlled analgesia following minimally invasive pectus excavatum repair: a systematic review and meta-analysis","volume":"49","author":"Stroud","year":"2014","journal-title":"J Pediatr Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/j.jpedsurg.2011.10.040","article-title":"Epidural vs. patient-controlled analgesia for postoperative pain after pectus excavatum repair: a prospective, randomized trial","volume":"47","author":"St. Peter","year":"2012","journal-title":"J Pediatr Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1111\/pan.12369","article-title":"A comparison of paravertebral nerve block catheters and thoracic epidural catheters for postoperative analgesia following the Nuss procedure for pectus excavatum repair","volume":"24","author":"Burton","year":"2014","journal-title":"Paediatr Anaesth"},{"key":"B12","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1111\/pan.12904","article-title":"Continuous chest wall ropivacaine infusion for analgesia in children undergoing Nuss procedure: a comparison with thoracic epidural","volume":"26","author":"Choudhry","year":"2016","journal-title":"Paediatr Anaesth"},{"key":"B13","doi-asserted-by":"publisher","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":"Graves","year":"2019","journal-title":"J Pediatr Surg"},{"key":"B14","doi-asserted-by":"publisher","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":"Keller","year":"2016","journal-title":"J Pediatr Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1093\/brain\/66.4.237","article-title":"Three types of nerve injury","volume":"66","author":"Brain","year":"1943","journal-title":"Brain"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/ijms21228652","article-title":"Peripheral nerve regeneration and muscle reinnervation","volume":"21","author":"Gordon","year":"2020","journal-title":"Int J Mol Sci"},{"key":"B17","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1007\/s00401-015-1482-4","article-title":"Role of macrophages in Wallerian degeneration and axonal regeneration after peripheral nerve injury","volume":"3","author":"Chen","year":"2015","journal-title":"Acta Neuropathol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/j.chest.2019.09.023","article-title":"Pleural cryobiopsy: a systematic review and meta-analysis","volume":"157","author":"Shafiq","year":"2020","journal-title":"Chest"},{"key":"B19","doi-asserted-by":"publisher","first-page":"00294","DOI":"10.1016\/j.jpedsurg.2023.05.006","article-title":"Forgotten branch of the intercostal nerve: implication for cryoablation nerve block for pectus excavatum repair","author":"Talsma","year":"2023","journal-title":"J Pediatr Surg"},{"key":"B20","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jss.2022.11.004","article-title":"Intercostal nerve cryoablation is associated with reduced opioid use in pediatric oncology patients","volume":"283","author":"Chen","year":"2023","journal-title":"J Surg Res"},{"key":"B21","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1007\/s00383-020-04768-z","article-title":"Use of cryoanalgesia as a postoperative pain management for open pectus carinatum repair","volume":"37","author":"Gologorsky","year":"2021","journal-title":"Pediatr Surg Int"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1076","DOI":"10.1016\/j.jpedsurg.2017.01.069","article-title":"Response to intercostal nerve cryoablation versus thoracic epidural catheters for postoperative analgesia following pectus excavatum repair","volume":"52","author":"Das","year":"2017","journal-title":"J Pediatr Surg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1213\/ANE.0000000000005857","article-title":"Are we ready for cryoablation in children undergoing Nuss procedures?","volume":"134","author":"Chidambaran","year":"2022","journal-title":"Anesth Analg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"791607","DOI":"10.3389\/fped.2021.791607","article-title":"Cryoanalgesia and lung isolation: a new challenge for the Nuss procedure made easier with the EZ-Blocker\u2122","volume":"9","author":"McCoy","year":"2021","journal-title":"Front Pediatr"},{"key":"B25","doi-asserted-by":"publisher","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":"Daemen","year":"2020","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1053\/j.sempedsurg.2018.05.010","article-title":"A review of anesthetic considerations and postoperative pain control after the Nuss procedure","volume":"27","author":"Singhal","year":"2018","journal-title":"Semin Pediatr Surg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"14","DOI":"10.17116\/hirurgia202105114","article-title":"Intercostal nerve cryoablation in correction of pectus excavatum in adults","volume":"5","author":"Pechetov","year":"2021","journal-title":"Khirurgiia (Sofiia)"},{"key":"B28","doi-asserted-by":"publisher","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":"Harbaugh","year":"2018","journal-title":"J Surg Res"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1148","DOI":"10.1089\/lap.2017.0665","article-title":"Cryoanalgesia in patients undergoing Nuss repair of pectus excavatum: technique modification and early results","volume":"28","author":"Morikawa","year":"2018","journal-title":"J Laparoendosc Adv Surg Tech A"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1383","DOI":"10.1089\/lap.2018.0111","article-title":"Outcomes using cryoablation for postoperative pain control in children following minimally invasive pectus excavatum repair","volume":"28","author":"Sujka","year":"2018","journal-title":"J Laparoendosc Adv Surg Tech A"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1244","DOI":"10.1089\/lap.2019.0203","article-title":"The use of cryoanalgesia in minimally invasive repair of pectus excavatum: lessons learned","volume":"29","author":"Parrado","year":"2019","journal-title":"J Laparoendosc Adv Surg Tech A"},{"key":"B32","doi-asserted-by":"publisher","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":"Zobel","year":"2020","journal-title":"Pediatr Surg Int"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1444","DOI":"10.1016\/j.jpedsurg.2019.09.021","article-title":"Postoperative pain control modalities for pectus excavatum repair: a prospective observational study of cryoablation compared to results of a randomized trial of epidural vs. patient-controlled analgesia","volume":"55","author":"Dekonenko","year":"2020","journal-title":"J Pediatr Surg"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1016\/j.jpedsurg.2019.09.016","article-title":"Use of cryoanalgesia for pain management for the modified Ravitch procedure in children","volume":"55","author":"Pilkington","year":"2020","journal-title":"J Pediatr Surg"},{"key":"B35","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1007\/s00383-020-04778-x","article-title":"Cryoablation is associated with shorter length of stay and reduced opioid use in pectus excavatum repair","volume":"37","author":"Rettig","year":"2021","journal-title":"Pediatr Surg Int"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1016\/j.jpedsurg.2021.03.017","article-title":"Cryoanalgesia enhances recovery from minimally invasive repair of pectus excavatum resulting in reduced length of stay: a case-matched analysis of NSQIP-pediatric patients","volume":"56","author":"Arshad","year":"2021","journal-title":"J Pediatr Surg"},{"key":"B37","doi-asserted-by":"publisher","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":"Aiken","year":"2021","journal-title":"J Pediatr Surg"},{"key":"B38","doi-asserted-by":"publisher","first-page":"2229","DOI":"10.1016\/j.jpedsurg.2021.03.006","article-title":"Intercostal cryoablation during Nuss procedure: a large volume single surgeon\u2019s experience and outcomes","volume":"56","author":"Sun","year":"2021","journal-title":"J Pediatr Surg"},{"key":"B39","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1055\/s-0041-1740555","article-title":"Percutaneous cryoanalgesia: a new strategy for pain management in pectus excavatum surgery","volume":"32","author":"Velayos","year":"2022","journal-title":"Eur J Pediatr Surg"},{"key":"B40","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/j.jpedsurg.2021.10.034","article-title":"Next day discharge after the Nuss procedure using intercostal nerve cryoablation, intercostal nerve blocks, and a perioperative ERAS pain protocol","volume":"57","author":"DiFiore","year":"2022","journal-title":"J Pediatr Surg"},{"key":"B41","doi-asserted-by":"publisher","first-page":"E29773","DOI":"10.1097\/MD.0000000000029773","article-title":"Limited cryoablation reduces hospital stay and opioid consumption compared to thoracic epidural analgesia after minimally invasive repair of pectus excavatum","volume":"101","author":"Song","year":"2022","journal-title":"Medicine (Baltimore)"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jss.2021.10.011","article-title":"Cryoanalgesia is associated with decreased postoperative opioid use in minimally invasive repair of pectus excavatum","volume":"271","author":"Arshad","year":"2022","journal-title":"J Surg Res"},{"key":"B43","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1097\/XCS.0000000000000103","article-title":"Impact of cryoablation on pectus excavatum repair in pediatric patients","volume":"234","author":"Clark","year":"2022","journal-title":"J Am Coll Surg"},{"key":"B44","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1016\/j.jpedsurg.2022.01.051","article-title":"Short and long term outcomes of using cryoablation for postoperative pain control in patients after pectus excavatum repair","volume":"57","author":"Fraser","year":"2022","journal-title":"J Pediatr Surg"},{"key":"B45","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1016\/j.jpedsurg.2022.01.044","article-title":"Infectious complications of intercostal nerve cryoablation mediated by perioperative hypothermia during pediatric Nuss procedure","volume":"57","author":"Bundrant","year":"2022","journal-title":"J Pediatr Surg"},{"key":"B46","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1016\/j.jpedsurg.2023.01.059","article-title":"Implementation of a cryoablation-based pain management protocol for pectus excavatum","volume":"58","author":"Cockrell","year":"2023","journal-title":"J Pediatr Surg"},{"key":"B47","doi-asserted-by":"publisher","first-page":"1430","DOI":"10.1016\/j.jpedsurg.2022.12.031","article-title":"Initial outcomes using cryoablation in surgical management of slipping rib syndrome","volume":"58","author":"Lai","year":"2023","journal-title":"J Pediatr Surg"},{"key":"B48","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1016\/j.jpedsurg.2023.01.028","article-title":"Development of a five point enhanced recovery protocol for pectus excavatum surgery","volume":"58","author":"Downing","year":"2023","journal-title":"J Pediatr Surg"},{"key":"B49","doi-asserted-by":"publisher","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":"Akinboro","year":"2023","journal-title":"Pediatr Surg Int"},{"key":"B50","doi-asserted-by":"publisher","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":"Perez Holguin","year":"2023","journal-title":"J Pediatr Surg"},{"key":"B51","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.jpedsurg.2022.09.032","article-title":"Effectiveness of one minute per level intercostal nerve cryoablation for postoperative analgesia after surgical correction of pectus excavatum","volume":"58","author":"Zeineddin","year":"2023","journal-title":"J Pediatr Surg"},{"key":"B52","doi-asserted-by":"publisher","first-page":"00570","DOI":"10.1016\/j.athoracsur.2023.04.044","article-title":"Evolution of pain control for adult pectus excavatum repair","author":"Jaroszewski","year":"2023","journal-title":"Ann Thorac Surg"},{"key":"B53","doi-asserted-by":"publisher","first-page":"1244","DOI":"10.1089\/lap.2022.0242","article-title":"Intercostal nerve cryoablation in minimally invasive repair of pectus excavatum: effect on pulmonary function","volume":"32","author":"Lai","year":"2022","journal-title":"J Laparoendosc Adv Surg Tech A"},{"key":"B54","doi-asserted-by":"publisher","first-page":"1258","DOI":"10.1016\/j.jpedsurg.2022.02.040","article-title":"Cryoablation is associated with shorter length-of-stay and reduced opioid use after the Ravitch procedure","volume":"57","author":"Rettig","year":"2022","journal-title":"J Pediatr Surg"},{"key":"B55","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/j.jpedsurg.2021.09.023","article-title":"Same-day discharge following the Nuss repair: a comparison","volume":"57","author":"Rettig","year":"2022","journal-title":"J Pediatr Surg"},{"key":"B56","first-page":"11","article-title":"Thoracoscopic cryoanalgesia: a new strategy for postoperative pain control in minimally invasive pectus excavatum repair","volume":"33","author":"Cadaval Gallardo","year":"2020","journal-title":"Cir Pediatr"},{"key":"B57","doi-asserted-by":"publisher","first-page":"614097","DOI":"10.3389\/fped.2020.614097","article-title":"A new device for thoracoscopic cryoanalgesia in pectus excavatum repair: preliminary single center experience","volume":"8","author":"Torre","year":"2020","journal-title":"Front Pediatr"},{"key":"B58","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.jpedsurg.2021.02.007","article-title":"Same day discharge for pectus excavatum\u2014is it possible?","volume":"57","author":"Rettig","year":"2022","journal-title":"J Pediatr Surg"},{"key":"B59","doi-asserted-by":"publisher","first-page":"1435","DOI":"10.1016\/j.jpedsurg.2022.10.051","article-title":"Cryoablation in 350 Nuss procedures: evolution of hospital length of stay and opioid use","volume":"58","author":"Lai","year":"2022","journal-title":"J Pediatr Surg"},{"key":"B60","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1177\/0218492314553442","article-title":"Quality of life improves after minimally invasive repair of pectus excavatum","volume":"23","author":"Kuru","year":"2015","journal-title":"Asian Cardiovasc Thorac Ann"},{"key":"B61","doi-asserted-by":"publisher","first-page":"29","DOI":"10.5090\/kjtcs.2016.49.1.29","article-title":"Pectus excavatum and pectus carinatum: associated conditions. Family history, and postoperative patient satisfaction","volume":"49","author":"Kuru","year":"2016","journal-title":"Korean J Thorac Cardiovasc Surg"},{"key":"B62","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1016\/S0022-3468(03)00123-4","article-title":"A pilot study of the impact of surgical repair on disease-specific quality of life among patients with pectus excavatum","volume":"38","author":"Lawson","year":"2003","journal-title":"J Pediatr Surg"},{"key":"B63","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1111\/nep.13706","article-title":"Where to look for the most frequent biases?","volume":"25","author":"Jager","year":"2020","journal-title":"Nephrology"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2023.1235120\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T23:32:02Z","timestamp":1692919922000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2023.1235120\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,24]]},"references-count":63,"alternative-id":["10.3389\/fsurg.2023.1235120"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2023.1235120","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,24]]},"article-number":"1235120"}}