Forgotten Branch of the Intercostal Nerve: Implication for Cryoablation Nerve Block for Pectus Excavatum Repair.
Collateral branch
Cryoablation
Cryoanalgesia
Intercostal nerve
Lateral cutaneous branch
Nuss procedure
Pectus excavatum
Journal
Journal of pediatric surgery
ISSN: 1531-5037
Titre abrégé: J Pediatr Surg
Pays: United States
ID NLM: 0052631
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
received:
07
04
2023
revised:
08
05
2023
accepted:
11
05
2023
medline:
8
11
2023
pubmed:
8
6
2023
entrez:
7
6
2023
Statut:
ppublish
Résumé
We first utilized and reported on the use of cryoanalgesia for postoperative pain control for Nuss procedure in 2016. We hypothesized that postoperative pain control could be optimized if the intercostal nerve anatomy is better understood. To test this hypothesis, human cadavers were dissected to elucidate the intercostal nerve anatomy. Cryoablation technique was modified. Cadaver Study: Adult cadavers were used to visualize the branching patterns of the intercostal nerves. Cryoablation: Posterior to the mid-axillary line for intercostal nerves 4, 5, 6 and 7, main intercostal nerve, lateral cutaneous branch and collateral branch were cryoablated under thoracoscopic view. Verbal pain scores were obtained from patients one day after the procedure. The study results were obtained during the years 2021 and 2022. Eleven cadavers were dissected. The path of the main intercostal and lateral cutaneous branch lie on the inferior rib surface of the corresponding intercostal nerve. Total of 92 lateral cutaneous branches of the intercostal nerve were dissected and measured as they pierced the intercostal muscle. Most lateral cutaneous branches of the intercostal nerve pierced the intercostal muscle anterior to midaxillary line 78.3%, posterior to midaxillary line 18.5% or on the midaxillary line 3.3%. The collateral branch of the intercostal nerve separated near the spine and traveled along the superior surface of the next inferior rib. Cryoablation: 22 male patients underwent Nuss procedure with cryoanalgesia. Median age of the patients was 15 years (IQR: 2), median Haller index was 3.73 (IQR: 0.85), median pain score (0-10 maximum pain) was 1 (IQR: 1.75). Cryoablation of the intercostal nerve and its two branches improves pain control after a Nuss procedure. Level 4. Observational study.
Sections du résumé
BACKGROUND
BACKGROUND
We first utilized and reported on the use of cryoanalgesia for postoperative pain control for Nuss procedure in 2016. We hypothesized that postoperative pain control could be optimized if the intercostal nerve anatomy is better understood. To test this hypothesis, human cadavers were dissected to elucidate the intercostal nerve anatomy. Cryoablation technique was modified.
METHODS
METHODS
Cadaver Study: Adult cadavers were used to visualize the branching patterns of the intercostal nerves. Cryoablation: Posterior to the mid-axillary line for intercostal nerves 4, 5, 6 and 7, main intercostal nerve, lateral cutaneous branch and collateral branch were cryoablated under thoracoscopic view. Verbal pain scores were obtained from patients one day after the procedure.
RESULTS
RESULTS
The study results were obtained during the years 2021 and 2022. Eleven cadavers were dissected. The path of the main intercostal and lateral cutaneous branch lie on the inferior rib surface of the corresponding intercostal nerve. Total of 92 lateral cutaneous branches of the intercostal nerve were dissected and measured as they pierced the intercostal muscle. Most lateral cutaneous branches of the intercostal nerve pierced the intercostal muscle anterior to midaxillary line 78.3%, posterior to midaxillary line 18.5% or on the midaxillary line 3.3%. The collateral branch of the intercostal nerve separated near the spine and traveled along the superior surface of the next inferior rib. Cryoablation: 22 male patients underwent Nuss procedure with cryoanalgesia. Median age of the patients was 15 years (IQR: 2), median Haller index was 3.73 (IQR: 0.85), median pain score (0-10 maximum pain) was 1 (IQR: 1.75).
CONCLUSION
CONCLUSIONS
Cryoablation of the intercostal nerve and its two branches improves pain control after a Nuss procedure.
LEVEL OF EVIDENCE
METHODS
Level 4.
TYPE OF STUDY
METHODS
Observational study.
Identifiants
pubmed: 37286412
pii: S0022-3468(23)00294-4
doi: 10.1016/j.jpedsurg.2023.05.006
pii:
doi:
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2435-2440Informations de copyright
Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.