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.

介绍 近年来，漏斗胸 (PE) 的疼痛方案已经通过胸腔镜方法纳入了冷冻镇痛。自 2019 年以来，超声引导下经皮冷冻镇痛 (PCr) 已在我们的机构中​​应用，无论是在 Nuss 手术的同一天还是在手术前 48 小时。我们对 2019 年至 2021 年间在我们机构进行了手术前 PCr 的 PE 患者进行了初步回顾性审查。

材料与方法 评价两组：手术当天PCr（PCrSD）和术前48小时PCr（PCr48）。尽管有 PCr，患者仍接受“患者自控镇痛”（PCA）和阿片类药物治疗至少 24 小时，随后几天转为常规静脉镇痛和口服镇痛。比较两组的人口统计学、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) 的疼痛等级和住院时间 (LOS)。总共包括 20 名患者（12 名患有 PCrSD，8 名患有 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)，各组之间没有差异。

结果 PCr48 组的连续 PCA 小时数中位数显着降低（24 小时 vs. 32 小时；p  = 0.031），救援推注的中位数更少（11 对 18小时；p  = 0.042），术后早期 VAS 中位数更低小时（2 对 5.5；p  = 0.043），以及较低的 LOS 中位数（3.5 对 5 天）。

结论 术前 48 小时进行的 PCr 在 PCA 要求、VAS 和 LOS 方面比同一天的冷冻镇痛更有效。