{
  "abstract": "Background and Aims Intercostal nerves cryoanalgesia addresses somatic pain after Nuss procedure for pectus excavatum, but visceral pain from mediastinal structures is conducted through phrenic nerves. We aimed to preliminarily assess whether combining cryoanalgesia with a bilateral phrenic analgesic infiltration was feasible, and whether this association reduced early postoperative pain compared with cryoanalgesia alone.Methods After ethical committee approval, a retrospective preliminary single-centre study involved 24 patients who underwent Nuss procedure from December 2023 to April 2025, allocated to 2 groups. Nine patients received ultrasound-guided percutaneous Earlier Preoperative Intercostal Cryoanalgesia (EPIC), from 4 to 7 days before surgery. Fifteen patients received cryoanalgesia with the same protocol. Additionally, they received a bilateral PHrenic Infiltration as Cryoanalgesia Adjuvant (PHICA) at the closing phase of surgery by placing, under ultrasound guidance, 10 ml levobupivacaine 0,25% in the fascial plane between sternocleidomastoid and anterior scalene muscles. Both groups received intravenous scheduled ibuprofen and acetaminophen, and rescue tramadol. Outcomes were limited to the Post-Operative Day 0 (POD-0). Pain was assessed every at least 3 hours by ward nurses, through Numerical Rating Scale (NRS). We evaluated pain scores, tramadol doses, incidence of adverse effects and ultrasound diaphragm excursion and thickness with a linear probe.Results Patients who experienced at least once moderate-severe pain, defined as NRS≥4, were 89% in the EPIC group, and 53% in the PHICA group. 22% of EPIC group patients needed rescue tramadol, compared to 13% of PHICA patients. Raw distribution of NRS values showed a median value for EPIC of 3 [1–5] and for PHICA of 1 [0–3] (p<0,001). Ultrasound diaphragm evaluations assessed appropriate excursion and thickening during normal and forced inspirations. Clinical adverse respiratory effects were absent.Conclusions This exploratory study may suggest the clinical feasibility and the possible advantage of addressing visceral pain through phrenic nerve infiltration, as a component of multimodal analgesia following pectus surgery.Abstract EP071 Figure 1Violin plot showing distribution density of all NRS values of postoperative day 0 among the groups. Box indicate IQR with median line. Whiskers extend to min/max values",
  "authors": [
    {
      "affiliations": [
        "Pediatric Anaesthesiology and Intensive Care Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy"
      ],
      "name": "Stefano Mariconti"
    },
    {
      "affiliations": [
        "Pediatric Anaesthesiology and Intensive Care Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy"
      ],
      "name": "Giulia Paris"
    },
    {
      "affiliations": [
        "Department of Emergency and Intensive Care, Hospital Papa Giovanni XXIII, Bergamo, Italy"
      ],
      "name": "Dario Bugada"
    },
    {
      "affiliations": [
        "Pediatric Anaesthesiology and Intensive Care Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy"
      ],
      "name": "Alfio Bronco"
    },
    {
      "affiliations": [
        "Pediatric Surgery, Hospital Papa Giovanni XXIII, Bergamo, Italy"
      ],
      "name": "Maurizio Cheli"
    },
    {
      "affiliations": [
        "Pediatric Anaesthesiology and Intensive Care Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy"
      ],
      "name": "Ezio Bonanomi"
    }
  ],
  "title": "EP071 Phrenic infiltration as cryoanalgesia adjuvant: a novel technique for postoperative pain management following nuss procedure for pectus excavatum",
  "uid": "044caad4-5257-575b-a2b3-ade67109aca3"
}