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Pediatric Chest Wall Program Research and Publications
Research
Combining Erector Spinae Plane Blockade and Cryoanalgesia to Manage Nuss Procedure Pain
This historical cohort study conducted by Shriners Hospitals for Children — Northern California and UC Davis Health researchers revealed that using a combination of Erector Spinae Plane Blockade (ESPB), cryoanalgesia and multimodal analgesia for the Nuss procedure resulted in low pain scores, low opioid consumption, and short length of stay. The effect of cryroanalgesia, administered during Nuss bar placement, is delayed for 24 hours or more. Using ESPB gives immediate analgesia to the chest wall area and acts as a bridge until cryroanalgesia reaches peak effect. This study was published in the International Journal of Anesthesiology & Research.
Local Anesthetic Infusion Eliminates Epidural Analgesia after the Nuss Procedure
Researchers at Shriners Hospitals for Children — Northern California and UC Davis Health compared outcomes of continuous subcutaneous infusion of local anesthetic to the use of epidural analgesia following the Nuss procedure. A retrospective chart review compared aspects of care for patients managed with these pain-relief regimens following the Nuss procedure from March 2013 to June 2015. The review revealed no difference in hospital length of stay or days on intravenous narcotics. Epidural catheter placement prolonged operating room time. Average pain scores were slightly higher in the subcutaneous infusion group but of negligible clinical significance. The team concluded that continuous subcutaneous infusion of local anesthetic could eliminate the need for thoracic epidural for pain management after the Nuss procedure. Results were published in Pain Management.
Cryoablation vs. Epidurals for Pain Relief following Nuss Bar Procedure
In this multi-institutional, retrospective review of 52 pediatric patients who underwent Nuss bar placement, researchers compared intercostal nerve cryoablation outcomes to prior outcomes using thoracic epidural analgesia. The cryoablation group had a significant reduction in the mean hospital length of stay, time in a monitored telemetry bed, total use of intravenous narcotics, and the duration of intravenous narcotic administration when compared to the thoracic epidural group. Cryoablation patients had a slightly higher rate of postoperative complications. Intercostal cryoablation has eliminated epidurals from practice for Nuss procedure pain relief at Shriners Hospitals for Children — Northern California. The study was published in the Journal of Pediatric Surgery.
Surgery for Chest Wall Deformities
Surgery for Chest Wall Deformities discusses treatment modalities for chest wall deformities pectus excavatum and pectus carinatum, including minimally invasive surgery. It is edited by Chest Wall Program surgeons Gary Raff, M.D., and Shinjiro Hirose, M.D. Surgeons and pediatric specialists from Shriners Hospitals for Children — Northern California and UC Davis Health contributed to the text book, including Amy Rahm, M.D. (Chapter 1, Surgical Anatomy of the Chest Wall), Karen Brand, BSN, R.N. (Chapter 9, Role of Nurse Practitioners in Chest Wall Clinics as a Model for Care), and Sundeep Tumber, D.O. (Chapter 5, Anesthetic Considerations for Chest Wall Surgery).
