Journal of Pediatric Surgery Article REview: August Issue 2023

Reduced opioid use and shorter length of stay in Nuss procedures was primarily related to discontinuing use of IV PCA during the study period, based on observation that patients weren't using the IV PCA.

IV PCA does not appear necessary in Nuss procedures with cryoablation and can be eliminated fairly early in a surgeon's experience.

The learning curve for cryoablation in Nuss procedures is not about surgical technique but about pain protocols, with earlier differences due to comfort level with discontinuing PCA and switching to oral pain medication rather than poor cryoablation technique.

Cryoablation implementation requires a protocol or regimen including pain team involvement preoperatively and postoperatively, with adjuncts such as gabapentin, rather than cryoablation alone.

Kansas City protocol for primary spontaneous pneumothorax involves small catheter placement mimicking aspiration, clamping, and chest X-ray at 6 hours, with success defined as equal or lower than 2 centimeter distance between chest wall and lung at apex and no air leak when clamp released.

Patients going to VATS immediately after failed aspiration had median length of stay of 3.1 days, compared to 6 days median length of stay for patients in the Midwest Pediatric Surgery Consortium.

Updated APSA guidelines for solid organ injury use APSA framework: A for admission (identifying ICU risk factors), P for procedures (focusing on angiography, when to operate, transfuse, or use angio suite), S for set free/discharge, and A for aftercare.

Phoenix Children's slipping rib syndrome study included 98 patients: 68 had rib resection without cryoablation (receiving other blocks like rectus spinae, paravertebral, or intercostal), 22 had extrathoracic cryoablation plus other nerve blocks, and 8 had slipping ribs resected as part of Nuss procedure.

91% of cryoablation patients had cryoablation of T9 and T10 intercostal nerves with no documented abdominal wall laxity at immediate follow-up of 16 days.

Patients who underwent rib excision with cryoablation used significantly less opioids in hospital compared to rib excision without cryoablation, with median length of stay of 1 day versus 2 days.

Patients with very low pectus deformities may have more discomfort in the lower costal margin area because it extends beyond the T7 and T8 field where most cryoablation is performed.