Intercostal Nerve Cryoablation for Postoperative Pain Control in Pediatric Thoracic Surgery: A Scoping Review.

Background: Cryoanalgesia uses the application of cold temperatures to temporarily disrupt peripheral sensory nerve function for pain control. This review outlines the principles of cryoablation, clinical applications, and clinical data for its use in pediatric thoracic surgery. Methods: A comprehensive PubMed search was performed using the principal terms and combinations of cryoablation, cryoanalgesia, Nuss, Nuss repair, pectus, pectus excavatum, thoracic surgery, thoracotomy, and chest wall. Pediatric articles were reviewed and included if relevant. Adult articles were reviewed for supporting information as needed. Reference lists of included articles were reviewed for possible additional sources. Discussion: The scientific and clinical principles of cryoablation are outlined, followed by a focused review of current clinical application and outcome data. Conclusion: Postoperative pain is a major challenge following thoracic surgery. Cryoanalgesia is emerging as an adjunct in pediatric thoracic surgery, particularly for the Nuss procedure or minimally invasive repair of pectus excavatum. It effectively controls pain, decreasing postoperative opioid use and hospital length of stay with few short-term complications. Although more long-term studies are needed, early evidence suggests there is reliable return of sensation to the chest wall and long-term neuropathic pain is rare.

Fat embolism syndrome with neurological involvement: A case report.

BACKGROUND: Fat Embolism Syndrome (FES) occurs when the contents (or some component of) the bone marrow is released into the circulation, generally as the result of long bone fracture. It poses significant challenges in both diagnosis and treatment and, as such, is primarily a diagnosis of exclusion with no definitive treatment. We present a case where heightened awareness of the clinical team allowed for early identification and immediate initiation of supportive care, nitric oxide (NO) for potential mitigation of right heart failure, and pharmacological treatment with atorvastatin. PATIENT: A 16-year-old male with multi-system trauma, including bilateral long-bone fractures, developed Fat Embolism Syndrome with neurological and respiratory symptoms within 24 h of admission. RESULTS: Within 24 h of initiation of high dose atorvastatin and inhaled Nitric Oxide our patient showed signs of improvement, including decreasing oxygen requirement's and normalization of mental status. CONCLUSION: We postulate that the combined therapy of high-dose atorvastatin with Nitric Oxide may have played a role in our patients' full recovery in a shortened timeframe. Ideally, further prospective research is needed to determine a universally accepted treatment regimen for pediatric patients with FES.