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  • Combined erector spinae plane block with surgical intercostal nerve cryoablation for Nuss procedure is associated with decreased opioid use and length of stay

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Original research
Combined erector spinae plane block with surgical intercostal nerve cryoablation for Nuss procedure is associated with decreased opioid use and length of stay
  1. Paola Aranda-Valderrama1,
  2. Robert S Greenberg1,2,
  3. Tricia M Vecchione1,
  4. Amanda G Finney3,
  5. Laura M Prichett3 and
  6. Samuel M Vanderhoek1
  1. 1Division of Pediatric Anesthesia, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  3. 3Biostatistics, Epidemiology and Data Management (BEAD) Core, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Samuel M Vanderhoek, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; svande20{at}jhmi.edu

Abstract

Background and objectives Pain management for patients undergoing the Nuss procedure for treatment of pectus excavatum can be challenging. In an effort to improve pain management, our institution added bilateral single injection erector spinae plane (ESP) blocks to surgeon placed intercostal nerve cryoablation. We aimed to assess the efficacy of this practice change.

Methods Retrospective clinical data from a single academic medical center were evaluated. Due to an institutional change in clinical management, we were able to perform a before and after study. Twenty patients undergoing Nuss procedure who received bilateral ultrasound-guided single-shot T6 level ESP blocks and intercostal nerve cryoablation were compared with a historical control cohort of 20 patients who underwent Nuss procedure with intercostal nerve cryoablation alone. The primary outcome variables included postoperative pain scores, total hospital opioid use, and hospital length of stay.

Results Median total hospital intravenous morphine milligram equivalents was lower for the ESP group than for the control group (0.60 (IQR 0.35–0.88) vs 1.15 mg/kg (IQR 0.74–1.68), p<0.01). There was no difference in postoperative pain scores between the two groups. Mean hospital length of stay was 2.45 (SD 0.69) days for the control group and 1.95 (SD 0.69) days for the ESP group (p=0.03). No adverse events related to block placement were identified.

Conclusions In a single-center academic practice, the addition of bilateral single injection ESP blocks at T6 to surgeon performed cryoablation reduced opioid consumption without a change in subjectively reported pain scores. The results from this pilot study can provide effect size estimates to guide the design of future randomized trials.

  • pain, postoperative
  • nerve block
  • treatment outcome

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/rapm-2023-104407

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors PA-V helped collect, analyze and interpret the data, and write the first draft and subsequent manuscript revisions. RG helped design the study, analyze and interpret the data, reviewed the first draft and subsequent manuscript revisions. TV helped design the study and reviewed the first draft and subsequent manuscript revisions. AF helped analyze and interpret the data, and write the first draft and subsequent manuscript revisions. LP helped analyze and interpret the data, and write the first draft and subsequent manuscript revisions. SV helped design and execute the study, collect, analyze and interpret the data, and write the first draft and subsequent manuscript revisions. SV accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.