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Eur J Pediatr Surg 2025; 35(06): 460-469
DOI: 10.1055/a-2596-3791
Original Article

Cryoanalgesia Plus Nerve Block Strategies versus Cryoanalgesia Alone in Patients with Pectus Excavatum Undergoing the Nuss Procedure: A Systematic Review and Meta-Analysis

Autoren

  • Kristine Santos 

    1   Department of Medicine, New Vision University School of Medicine, Tbilisi, Georgia

  • Karen Aoke

    2   Department of Medicine, Positivo University, Curitiba, Paraná, Brazil

  • Vrushali Shelar

    3   V.I. Razumovsky Saratov State Medical University of the Ministry of Health of the Russian Federation, Saratov, Saratov Oblast, Russian Federation

  • Mario Lira

    4   Juarez University of Durango State Faculty of Medicine and Nutrition, Durango, Dgo., Mexico

  • Felipe Passos

    5   Department of Thoracic Surgery, Hospital Mater Dei, Salvador, Brazil
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Graphical Abstract

Abstract

Background

Cryoanalgesia (CA) has shown promise in managing postoperative pain in patients undergoing the Nuss procedure for pectus excavatum, but has a delayed onset. Adjunctive regional anesthesia, such as nerve blocks (NBs), may enhance early analgesia. Our meta-analysis aims to evaluate the comparative efficacy of combining CA with NB (CNB) versus CA alone.

Methods

A literature search was conducted focusing on studies that compared CNB and CA alone for postoperative pain management following the Nuss procedure. RevMan 8.13.0 was used to calculate effect estimates reported as mean differences (MDs), with 95% confidence intervals (CIs).

Results

Three observational studies comprising a total of 161 patients were included. Of these, 71 patients (44.1%) received the combined treatment of CNB. CNB was associated with significantly shorter hospital stays (MD −0.51 days; 95% CI −0.80 to −0.21; p < 0.05; I 2 = 0%), reduced postoperative opioid consumption (MD −0.74 OME/kg; 95% CI −1.16 to −0.32; p < 0.05; I 2 = 35%), and lower postoperative pain scores on postoperative day (POD) 3 (MD −1.03 points; 95% CI −1.76 to −0.30; p < 0.05; I 2 = 0%). No significant differences were observed in operative duration or postoperative pain scores on POD 0, 1, and 2.

Conclusion

CNB may be associated with improved postoperative outcomes compared with CA alone in patients undergoing the Nuss procedure. However, given the small sample size and the observational nature of the included studies, further high-quality randomized controlled trials are needed to validate these findings and inform clinical practice.

Keywords

nerve block - cryoanalgesia - Nuss - pectus excavatum

Data Availability

The data underlying this article are available in the article and its online supplementary material.


Supplementary Material



Publikationsverlauf

Eingereicht: 11. Februar 2025

Angenommen: 27. April 2025

Accepted Manuscript online:
29. April 2025

Artikel online veröffentlicht:
03. Juni 2025

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