Pediatric Surgeon Freezes Nerves to Reduce Pain, Need for Opioids

November 24, 2020
By: NHRMC
Mason English

Dr. Jeff Dehmer sees multiple patients each year who have a condition called pectus excavatum, where a person’s chest bows in and can slowly start to compress the heart and lungs.

The pediatric surgeon at New Hanover Regional Medical Center used to have to tell patients that, to fix the condition, they’d need to undergo a painful surgery, spend up to a week in the hospital, and need strong pain medication frequently over the following month.

Now, with a new technique that involves freezing nerves in the chest wall during surgery, patients can go home in as few as two days -- and they’ll feel much less pain during their recovery.

What Is Pectus Excavatum?

Pectus excavatum is a condition where the cartilage in the chest (between the ribs and the sternum) begins to slowly bow in, usually as a person hits puberty. The condition can develop without symptoms, but it can compress the heart and lungs and cause shortness of breath, particularly with exercise, Dr. Dehmer said. It also can lead to body image issues for the patient since the chest appears sunken in.

Pectus excavatum is more likely to occur in white males, and it’s fairly common, occurring in one of 300-400 births. Dr. Dehmer sees numerous patients each year with the condition.

To correct it, Dr. Dehmer makes two incisions on either side of the chest (and another small incision for a camera), then inserts a stainless steel bar behind the sternum. He flips the bar, which pops the chest out instantly. The bar stays in the patient’s chest for about three years (usually until the patient stops growing), then it’s removed in an outpatient surgery.

Popping the chest out with a metal bar causes significant pain. Dr. Dehmer’s new technique doesn’t change the procedure, but does change how the pain is managed after the operation. Before, patients either took high doses of narcotics or had an epidural catheter, and they would stay on opioids for several weeks after the surgery. Now, Dr. Dehmer freezes the nerves in the chest wall where the stainless steel bar is placed. That numbness lasts for about three months. It doesn’t damage or kill the nerve; it just freezes it until the worst surgical pain has worn off, Dr. Dehmer said.

This change lessens the chance the patients - typically teenagers - could develop opioid dependency.

“Undertreating surgical pain, nobody wants to do that,” Dr. Dehmer said. “But caution is warranted to make sure we’re judicious about using those types of medications.”

Mason’s Story

Mason English, 16, was the first patient at NHRMC to undergo the surgery with the new technique.

Mason, who is a junior at Laney High School, came to NHRMC earlier this year with a lingering flu-like illness. In the midst of checking his symptoms, his doctors discovered he had pectus excavatum, and they recommended he get the surgery.

“At first, I didn’t really want to do it, but I realized it could get worse,” Mason said.

Dr. Dehmer “said it wasn’t super terrible now. But they said it could get worse the more my bones grew.”

When Mason woke up after the surgery on September 10, he felt very little pain.

“It hurt sometimes, but rarely,” he said. “It was just a little hard to move around.”

Two days after the procedure, he was taking walks around the hospital. Now, he’s just starting to experience a bit more pain when he sleeps on his chest -and he thinks that’s because his nerves are thawing out. He says he can easily manage that pain with Tylenol.

Overall, Mason said the surgery isn’t “a big deal.”

“It’s a few months where you can’t do a lot, but after three months, it’s like you never had it done,” he said. “Besides the metal bar.”

For more information on pediatric surgery at NHRMC, visit www.nhrmc.org/services/pediatrics/pediatric-surgery.

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