Post-operative pain is a significant problem that frequently leads to an extended hospital stay despite the technically minimally invasive surgery.
Multi-modal pain management techniques have been used with differing degrees of effectiveness. But, constant consumption of painkillers can lead to another health problem, or even worse, opioid addiction.
Side Effects of Opioids After Pectus Surgery
Opioids are more potent pain relievers. They are mainly used to treat severe pain following any pectus surgery.
They include morphine and codeine.
Some side effects of opioids are:
- Drowsiness
- Nausea
- Constipation
- Itching
- It can impact urine and respiration; if taken in excess.
- Depress respiration, resulting in slow, shallow breaths.
This can lower the quality of life for a pectus patient for an extended period.
The worst scenario is that they can cause significant injury, including overdose and death. That is why it is critical to use them as directed by your doctor and to avoid relying on them forever. You have to be conscious of their effect.
Listen to Your Doctor’s Advice
Your doctor will advise you on managing discomfort after your pectus excavatum surgery. The type and amount of pain medication use vary.
It will depend on your general health and the type of operation you have. Some pain relievers may interact with other medicines.
Opioid Addiction
Studies suggest that 6% of patients who receive an opioid prescription after surgery will continue taking them three to six months later, becoming addicted.
The risk of long-term addiction increases with increasing dosage and duration of opioid use during recovery. That underscores the importance of a surgeon's prescribing practices.
So, that information urges me to advise you to do your research and pick a surgeon carefully. As a patient, you must prepare mentally for the following period.
Cryoablation for Nuss Procedure
Cryoablation is a process whereby tissue is frozen and destroyed using a cryoprobe or a freezing liquid.
It is a new strategy for eliminating severe pain following thoracoscopic treatment from the Nuss Procedure. Patients benefit by drastically lowering hospital stay and the requirement for narcotic analgesics.
The difference maker is intraoperative cryoablation of the intercostal nerves.
According to Cleveland Clinic, Cryoablation has made the pain experienced by pectus patients far more tolerable.
Great for Kids
This study shows cryoablation also reduces the need for pre-operative opioids and post-operative problems while slightly lengthening the surgical procedure.
In the surgical treatment of chest wall abnormalities in children, cryoablation is a powerful pain management technique. Patients using this method have a much better experience with pain after surgery.
Before this technique, a month or more is required for rehabilitation after surgery. That meant school-age kids had surgery during the summer to avoid missing school.
Because of cryoablation benefits, patients now have more freedom in organizing and preparing their pectus excavatum operation and post-operative process.
How It Starts
The cryoablation process starts before Nuss bar implantation by making bilateral transverse incisions in the axilla and inserting a thoracoscope to facilitate the correct placement of the cryoprobe tip against each nerve.
Your medical team will ask about your current medication before the treatment because some drugs, such as blood thinners, may need to be stopped before the procedure is scheduled. Blood tests may also be required to ensure that your immune response and blood clotting capacity are sufficient.
Before your consultation, your care team will inform you of any dietary restrictions.
Some surgeons who use intercostal cryoablation have observed a modest increase in pneumothorax incidence.
They might be related to mild lung fracture caused by unintentional adhesion to the cryoprobe or the brief ice ball it leaves behind.
A specialized pectus excavatum doctor from the Cleveland Clinic says that an adequate solution to reduce this danger is to isolate and collapse the lung on the side where cryoablation is conducted using a double-lumen endotracheal tube.
Side Effects
Potential Bar Dislocation
While cryoablation reduces post-operative pain significantly, it has an accidental side effect. The most common one is a Nuss bar displacement. Some pain-free patients can easily forget their physical activity restrictions and accidentally displace their Nuss bar, which may necessitate surgical adjustment.
Nerve Damage
Other, less frequent side effects include nerve damage resulting in weakness or numbness and potential infection from any skin incision.
10 Sources
- Cryoablation: Cryotherapy, Cryosurgery [Internet]. Cleveland Clinic. [cited 2022 Dec 4]. Available from: https://my.clevelandclinic.org/health/treatments/16903-cryoablation
- Definition of cryoablation - NCI Dictionary of Cancer Terms - NCI [Internet]. 2011 [cited 2022 Dec 4]. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/cryoablation
- Freezing Out Pain: Intercostal Cryoablation is Improving Pectus Excavatum Recovery – Consult QD [Internet]. [cited 2022 Dec 4]. Available from: https://consultqd.clevelandclinic.org/freezing-out-pain-intercostal-cryoablation-is-improving-pectus-excavatum-recovery/
- Clark RA, Jacobson JC, Singhal A, Alder AC, Chung DH, Pandya SR. Impact of Cryoablation on Pectus Excavatum Repair in Pediatric Patients. J Am Coll Surg. 2022 Apr 1;234(4):484–92.
- Bachmutsky I, Wei XP, Kish E, Yackle K. Opioids depress breathing through two small brainstem sites. Elife. 2020 Feb 19;9:e52694.
- staff familydoctor org editorial. Pain Control After Surgery: Pain Medicines [Internet]. familydoctor.org. 2000 [cited 2022 Dec 4]. Available from: https://familydoctor.org/pain-control-after-surgery-pain-medicines/
- Hao D, Saddawi-Konefka D, Low S, Alfille P, Baker K. Placement of a Double-Lumen Endotracheal Tube. New England Journal of Medicine. 2021 Oct 14;385(16):e52.
- Papic JC, Finnell SME, Howenstein AM, Breckler F, Leys CM. Postoperative opioid analgesic use after Nuss versus Ravitch pectus excavatum repair. J Pediatr Surg. 2014 Jun;49(6):919–23; discussion 923.
- Lucas JA Elizabeth. Surgeons’ Opioid-Prescribing Habits Are Hard To Kick [Internet]. Kaiser Health News. 2019 [cited 2022 Dec 4]. Available from: https://khn.org/news/surgeons-opioid-prescribing-habits-hard-to-kick/
- What is Cryoablation? Risks & Benefits | MedStar Health [Internet]. [cited 2022 Dec 4]. Available from: https://www.medstarhealth.org/services/cryoablation