Purpose

Intercostal Nerve Cryoablation (INC) has significantly improved pain control following the Nuss repair of pectus excavatum (PE). This study sought to evaluate patients undergoing the Nuss repair with INC compared to the Nuss repair with an ERAS protocol, INC, and intercostal nerve blocks (INB).

Methods

In June 2020, a new protocol was implemented involving surgery, anesthesia, nursing, physical therapy, and child life with the goal of safe same day discharge for patients undergoing the Nuss repair. They were compared to a control group who underwent the Nuss repair with INC alone in 2017–2019. The primary outcome measure was hospital length of stay (LOS) in hours, secondary outcomes were number of patients discharged on postoperative day (POD) 0, and returns to the emergency department (ED), urgent care (UC), and operating room (OR).

Results

The characteristics between the groups were the same (Table 1). The mean LOS was 11.8 h in the INB group versus 58.2 h in the INC group, p < 0.01. 10 of 15 patients in the INB group went home on POD 0 (average of 5.5 h postop), versus 0 patients in the INC only group, p < 0.01. Five patients in the INB stayed overnight. Two patients stayed owing to anxiety, one owing to urinary retention, one owing to nausea, and one owing to drowsiness. None stayed for pain control. Four patients in the INC group returned to the ED for pain control, versus 0 in the INB group, and 1 patient in the INB returned to UC for constipation.

Conclusions

The majority of patients undergoing the Nuss repair of PE with a multidisciplinary regimen of pre and postoperative nursing education, precise intraoperative anesthesia care, performance of direct vision INB and INC, as well as careful surgery can go home on the day of surgery without adverse outcomes or unanticipated returns to the hospital.

Level-of-evidence

Level II.

中文翻译：

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Nuss 修复后的当天出院：比较

目的

肋间神经冷冻消融术 (INC) 显着改善了漏斗胸 (PE) 的 Nuss 修复后的疼痛控制。本研究旨在评估使用 INC 进行 Nuss 修复的患者与使用 ERAS 方案、INC 和肋间神经阻滞 (INB) 进行 Nuss 修复的患者。

方法

2020 年 6 月，实施了一项涉及手术、麻醉、护理、物理治疗和儿童生活的新方案，目标是让接受 Nuss 修复的患者当天安全出院。他们与在 2017-2019 年仅接受 INC 进行 Nuss 修复的对照组进行比较。主要结局指标是以小时为单位的住院时间（LOS），次要结局指标是术后第 0 天（POD）出院的患者人数，以及返回急诊室（ED）、紧急护理（UC）和手术室的人数（或者）。

结果

各组之间的特征相同（表1）。INB 组的平均 LOS 为 11.8 小时，而 INC 组为 58.2 小时，p  < 0.01。INB 组 15 名患者中有 10 名在 POD 0（术后平均 5.5 小时）回家，而仅 INC 组中有 0 名患者，p  < 0.01。INB 的五名患者过夜。两名患者因焦虑留下，一名因尿潴留，一名因恶心，一名因嗜睡。没有人留下来控制疼痛。INC 组有 4 名患者返回 ED 进行疼痛控制，而 INB 组为 0 名，INB 中有 1 名患者因便秘返回 UC。

结论

大多数接受 Nuss 修复的 PE 患者，通过术前和术后护理教育、精确的术中麻醉护理、直视 INB 和 INC 的执行以及仔细的手术等多学科方案，可以在手术当天回家而没有不良后果或意外返回医院。

证据水平

二级。