双点冷冻消融对 Nuss 术后疼痛控制的影响
IMPACT OF 2-SITE CRYOABLATION ON PAIN CONTROL AFTER THE NUSS PROCEDURE.
作者
作者单位
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: difiorj@ccf.org.
摘要
中文
肋间神经冷冻消融(cryo)可减少 Nuss 术后阿片类药物使用及住院时间(LOS)。传统冷冻消融仅针对肋间神经(ICN)主干。已有研究提出双点技术,即额外冷冻处理侧支,可能进一步改善术后镇痛效果。我们回顾性分析了 2023 年 1 月至 2026 年 1 月期间使用 Park 系统接受 Nuss 手术的 ≤21 岁患者。第 1 组接受标准单点冷冻消融(肋骨下方,靶向 ICN 主干);第 2 组接受双点冷冻消融,在下一肋骨上方增加一次冷冻,同时靶向 ICN 主干及侧支。比较术后疼痛评分、阿片类药物用量(静脉及口服吗啡当量[OME])及住院时间。共纳入 82 例患者:43 例(52.4%)接受单点冷冻,39 例(47.6%)接受双点冷冻。两组人口学特征、支撑棒数量及畸形严重程度(平均 Haller 指数 4.9 vs 4.4,p = 0.09)相似。在院术后平均疼痛评分无差异(单点组:2.9 ± 1.7 vs 双点组:2.2 ± 1.4,p = 0.1),但最低疼痛评分显著改善(单点组:0.4 ± 1.2 vs 双点组:0.0 ± 0.0,p = 0.03)。此外,术后静脉阿片类用量(21.0 ± 36.4 vs 13.0 ± 15.9 OME,p = 0.81)、口服阿片类用量(50.9 ± 48.7 vs 46.4 ± 32.3 OME,p = 0.98)及住院时间(31.8 ± 20.6 vs 28.8 ± 12.2 小时,p = 0.75)均无显著差异。双点冷冻消融在平均疼痛评分上有轻度数值下降,在最低疼痛评分上有统计学显著改善,但未转化为阿片类药物用量或住院时间的显著差异。扩大样本量的双点冷冻消融研究可能更有能力检出这些指标的细微改善。
English
Intercostal nerve cryoablation (cryo) reduces opioid use and hospital length of stay (LOS) following the Nuss procedure. Traditionally, cryoablation targets only the main branch of the intercostal nerve (ICN). A 2-site technique has been proposed to additionally target the collateral ICN branch, potentially improving postoperative analgesia. We retrospectively analyzed patients ≤21 years of age who underwent the Nuss procedure with the Park System from 01/2023 to 01/2026. Group 1 underwent standard single-site cryoablation inferior to the rib, targeting the main ICN (1-site cryo). Group 2 underwent two-site cryoablation with an additional freeze at the superior aspect of the rib below, targeting both the main ICN and collateral branch (2-site cryo). Postoperative pain scores, opioid utilization (IV and oral morphine equivalents [OME]), and hospital LOS were compared. Eighty-two patients were included: 43 (52.4%) received 1-site cryo and 39 (47.6%) received 2-site cryo. Groups were similar in demographics, bar number, and deformity severity (mean Haller Index 4.9 vs 4.4, p=0.09). There was no change in the average in-house, postoperative pain score (1-site: 2.9 ± 1.7 vs. 2-site: 2.2 ± 1.4, p=0.1), but lowest pain scores were significantly improved (1-site: 0.4 ± 1.2 vs. 2-site: 0.0 ± 0.0, p=0.03). In addition, there were no significant differences in postoperative IV opioid use (21.0 ± 36.4 vs 13.0 ± 15.9 OME, p=0.81), oral opioid use (50.9 ± 48.7 vs 46.4 ± 32.3 OME, p=0.98), or LOS (31.8 ± 20.6 vs 28.8 ± 12.2 hours, p=0.75). 2-site cryoablation produces modest numerical reduction in average pain scores and statistically significant reduction in lowest pain scores which did not translate into statistically significant differences in opioid consumption or hospital length of stay. Further studies of 2-site CRYO with larger study groups may be better powered to detect smaller improvements in these parameters.
分类与指标
- 研究类型
- 临床研究
- 病种
- 气胸·外伤·胸壁
- JCR 分区
- Q2
- 影响因子
- 2.3
- 新锐分区
- 2区