Background and Aims The management of acute pain during surgical correction of the funnel chest is an interdisciplinary challenge. For the first time in Poland (in May 2022) intraoperative cryolesia was performed using Cryo-S Painless Metrum Cryoflex device during minimally invasive modified Nuss surgery in the Department of Pediatric Orthopedics and Oncology of Musculoskeletal System of Pomeranian Medical University in Szczecin, Poland. The aim of the study was to compare the short and long-term effectiveness of intercostal cryoanalgesia in terms of pain relief, risk of sensory disturbances and patient comfort.

Methods A total of 100 patients who were operated on with the Nuss method were enrolled. The control group of 52 patients (15 years +/- 2, 4 girls) had multimodal analgesia protocol according to the standard of acute pain management in children. The intervention group of 48 patients (15 years +/- 3 years, 5 girls) had intraoperative intercostal cryolesia bilaterally from Th3 to Th8.

Results In the intervention group significantly better control of postoperative pain assessed according to the numerical rating scale (NRS) in the first postoperative days (p<0.01) was achieved. Additionally, there was shorter duration of intravenous opioid use (p<0.01), faster independence and correctness of exercises performed during postoperative rehabilitation (p<0.01) and shorter hospitalisation time (p<0.01). In the intervention group, better results were obtained in terms of quality of life according to the modified Nuss questionnaire. Conclusion

Conclusions Adding cryolesia to multimodal analgesia during modified Nuss surgery gives better results in terms of pain control, improved rehabilitation, and reduced hospitalisation time.