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Eur J Pediatr Surg
DOI: 10.1055/a-2708-2796
Review Article

Intercostal Nerve Cryoablation for Postoperative Pain Control After the Nuss Procedure in Children: A Systematic Review and Meta-Analysis

Authors

  • Diogo Marques

    1   Faculty of Medicine, University of Porto, Porto, Portugal

  • Rafael Vieira

    2   Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal; RISE-Health, Faculty of Medicine, University of Porto, Porto, Portugal

  • Ana Fragoso

    3   Department of Pediatric Surgery, Unidade Local de Saúde de São João, Porto, Portugal; RISE-Health, Faculty of Medicine, University of Porto, Porto, Portugal

  • Tiago Tuna

    3   Department of Pediatric Surgery, Unidade Local de Saúde de São João, Porto, Portugal; RISE-Health, Faculty of Medicine, University of Porto, Porto, Portugal
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Graphical Abstract

Abstract

Introduction

Nuss procedure is the standard technique for pectus excavatum repair. Despite its minimally invasive nature, this procedure is associated with significant postoperative pain and high opioid consumption. Intercostal nerve cryoablation (INC) has emerged as an adjunct to multimodal analgesia (MMA) to improve pain control, reduce opioid use, and shorten length of stay (LOS). This systematic review aims to assess INC outcomes following the Nuss procedure in pediatric patients.

Materials and Methods

A systematic search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library databases through December 2024. Studies comparing INC with standard MMA, with or without thoracic epidural, in pediatric patients undergoing the Nuss procedure were included. The primary outcome was LOS, and the secondary outcomes were opioid consumption, postoperative pain, complications, operative time, and hospitalization costs. Risk of bias was determined using the National Institutes of Health assessment tool. Meta-analysis was performed using R software.

Results

Eleven studies met the inclusion criteria, comprising 922 patients (476 INC and 446 control). INC significantly reduced LOS (−2.2 days; 95% CI: −2.8 to −1.8) at the expense of increased operating room time (+23 minutes; 95% CI: 10–39). Qualitative analysis showed reduced opioid use and comparable pain scores and complication rates with INC, while its impact on costs was conflicting.

Conclusion

INC reduces LOS and opioid use in pediatric patients undergoing the Nuss procedure without increasing complications. Further studies are needed to assess long-term safety and cost-effectiveness.

Keywords

cryoablation - pectus excavatum - Nuss procedure

Contributors' Statement

Study conception, design, and critical revision: D.M., T.T., and A.F. Data acquisition and drafting of the manuscript: D.M. and T.T. Analysis and data interpretation: R.V., D.M., and T.T.


Supplementary Material



Publication History

Received: 01 April 2025

Accepted: 23 September 2025

Accepted Manuscript online:
24 September 2025

Article published online:
07 October 2025

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