Postoperative outcomes after off-label cryoanalgesia during minimally invasive repair of pectus excavatum in children younger than 12 years.

Background: Intraoperative cryoanalgesia has been widely adopted to reduce postoperative pain, opioid use, and length of stay after minimally invasive repair of pectus excavatum (MIRPE). However, its use in children younger than 12 years remains off-label, and outcomes in this age group are poorly characterized. This study evaluated postoperative outcomes after cryoanalgesia during MIRPE in carefully selected children younger than 12 years. Methods: We performed a single-center retrospective chart review of patients younger than 12 years who underwent MIRPE with thoracoscopic transthoracic cryoanalgesia between August 2019 and July 2023. Patients receiving epidural analgesia or patient-controlled analgesia were excluded. Primary outcomes were inpatient opioid consumption, converted to oral morphine equivalents per kilogram (OME/kg), and hospital length of stay. Secondary outcomes included inpatient pain scores, postoperative sensory symptoms, and complications. Results: Ten patients met inclusion criteria. The mean age was 10.1 ± 0.9 years, and 70% were male. Median total inpatient opioid consumption was 0.96 OME/kg (IQR, 0.47-1.17), and median length of stay was 2 days (IQR, 2-3). Median inpatient pain scores decreased from 2 (IQR, 0-4) on postoperative day 0 to 0 (IQR, 0-2) on postoperative day 1. Two postoperative complications occurred; neither was directly attributable to cryoanalgesia. Among patients with available follow-up, no persistent pain, paresthesia, or numbness was reported by 9 months postoperatively. Conclusions: Off-label cryoanalgesia during MIRPE in children aged 9-11 years was feasible and associated with low opioid use, acceptable pain control, short length of stay, and no cryoanalgesia-related complications. Larger prospective studies are needed.