Recovery After Chest Wall Surgery

Advanced Recovery Standards for Pediatric Chest Wall Patients

WakeMed’s pediatric chest wall program had developed its own Enhanced Recovery After Surgery (ERAS) protocol designed to improve recovery, minimize pain, decrease the risk of hospital readmission and help patients return to regular activities as quickly as possible.

Our ERAS protocol was developed by our surgeons, anesthesiologists, nurse practitioners, pharmacists, and physical therapists to synthesize and integrate up-to-date “best practices” within all of our fields.

One of the most important principles of ERAS is to use “multimodal pain management” to target two or more different drug classes and non-pharmacologic therapies to attack pain through multiple pathways at the same time. For example, anti-inflammatory medications such as ketorolac (Toradol) and ibuprofen (Motrin) can be combined with muscle relaxers such as cyclobenzaprine (Flexeril) to reduce the need for postoperative narcotics. More importantly, direct attacks on the nerves in the chest wall (such as intercostal nerve blocks and cryoanalgesia) can dramatically decrease the need for intravenous and oral pain medicine.

Cryoablation (also called cryoanalgesia or cryoneurolysis)

As part of these evidence-based standards, cryoablation (cryo) has quickly become the standard of care for pain management during chest wall procedures. Cryo uses extreme cold to “freeze” the chest wall nerves. The effect typically lasts about three months and then sensation returns. By temporarily interrupting pain signals from the intercoastal nerves, cryo significantly reduces postoperative discomfort and decreases the need for opioid medications during recovery. Cryo is performed during the chest wall operation by the surgical team, and therefore doesn’t require any additional surgical care.

The result is a more comfortable healing experience, earlier mobility, shorter hospital stay and improved outcomes for patients and their families.