INTRODUCTION  In recent years, pain protocols for pectus excavatum (PE) have incorporated cryoanalgesia through thoracoscopic approach. Since 2019, ultrasound-guided percutaneous cryoanalgesia (PCr) has been applied at our institution, either on the same day as the Nuss procedure or 48 hours before surgery. We carried out a preliminary retrospective review of patients with PE in whom PCr prior to surgery was performed at our institution between 2019 and 2021. MATERIALS AND METHODS  Two groups were evaluated: PCr on the same day (PCrSD) and PCr 48 hours before surgery (PCr48). Despite PCr, patients were treated with "patient-controlled analgesia" (PCA) with opioids for at least 24 hours, switching to conventional intravenous analgesia and oral analgesia in the following days. Demographic, clinical-radiological variables, PCA opioid use, pain grade according to the visual analog scale (VAS), and length of stay (LOS) were compared between the groups. A total of 20 patients were included (12 with PCrSD and 8 with PCr48), without significant differences in demographics or clinical-radiological variables. The overall median time of PCr was 65 minutes (55-127), with no differences between the groups. RESULTS  PCr48 group presented with significantly lower median number of hours of continuous PCA (24 vs. 32 hours; p = 0.031), lower median number of rescue boluses (11 vs. 18; p = 0.042), lower median VAS in the early postoperative hours (2 vs. 5.5; p = 0.043), and lower median LOS (3.5 vs. 5 days). CONCLUSION  PCr performed 48 hours prior to surgery is more effective in terms of PCA requirements, VAS, and LOS when compared with cryoanalgesia on the same day.

中文翻译：

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经皮冷冻镇痛：漏斗胸手术疼痛管理的新策略。

引言 近年来，漏斗胸 (PE) 的疼痛方案已通过胸腔镜方法纳入冷冻镇痛。自 2019 年以来，我们机构在 Nuss 手术的同一天或手术前 48 小时应用了超声引导下的经皮冷冻镇痛 (PCr)。我们对 2019 年至 2021 年间在我院进行术前 PCr 的 PE 患者进行了初步回顾性审查。 PCr48)。尽管进行了 PCr，患者仍接受阿片类药物“患者自控镇痛”(PCA) 治疗至少 24 小时，随后几天改用常规静脉镇痛和口服镇痛。人口统计学、临床放射学变量、PCA 阿片类药物的使用、根据视觉模拟量表（VAS）的疼痛分级和住院时间（LOS）在各组之间进行比较。共纳入 20 名患者（12 名 PCrSD 和 8 名 PCr48），人口统计学或临床放射学变量没有显着差异。PCr 的总体中位时间为 65 分钟 (55-127)，组间无差异。结果 PCr48 组持续 PCA 的中位小时数显着降低（24 对 32 小时；p = 0.031），抢救推注的中位数更少（11 对 18；p = 0.042），术后早期的中位 VAS 更低小时（2 对 5.5；p = 0.043）和较低的中位 LOS（3.5 对 5 天）。结论 术前 48 小时进行 PCr 在 PCA 需求、VAS 和 LOS 方面与当天冷冻镇痛相比更有效。