Nerve freezing technique reduces pain after surgical repair for microtia

Ann & Robert H. Lurie Children's Hospital of Chicago is the first in the world to eliminate months of pain after surgical repair for microtia – a rare condition where a child is born with underdeveloped or missing outer ear. Previously, children with microtia suffered prolonged postoperative pain because cartilage for ear reconstruction is harvested from one of their ribs. Now, prior to plastic surgery, Lurie Children's specialists freeze the nerve at the rib harvesting site through a minimally invasive, ultrasound-guided procedure that lasts only 20 minutes. Patients can go home without pain as early as a day after surgery.

Experience with this groundbreaking approach in the first three patients was recently reported in Plastic and Reconstructive Surgery, journal of the American Society of Plastic Surgeons. Currently, over 30 patients have benefited from this method to control pain, with reduced opioid use and shorter hospital stays.

Severe pain after a rib harvest was a major challenge in microtia repair that uses the patient's own tissue to reconstruct the ear. Remarkably, pain is no longer a concern during recovery, so opioids are mostly eliminated and kids go home sooner. This is monumental."

Akira Yamada, MD, PhD, senior author, plastic surgeon at Lurie Children's and Professor of Pediatric and Plastic Surgery at Northwestern University Feinberg School of Medicine

By removing pain, freezing the nerve at the rib harvesting site allows patients to enjoy the full benefits of natural ear reconstruction, including lifelong ear sensation and normal appearance, explained Dr. Yamada. The alternative was to use artificial cartilage for the reconstruction, but the ear then does not look natural, nor does it have any sensation.

"Our innovation removes the pain obstacle from natural ear reconstruction," said co-author Shankar Rajeswaran, MD, Division Head of Interventional Radiology at Lurie Children's and Associate Professor of Radiology at Northwestern University Feinberg School of Medicine. "It is a paradigm shift in how we approach pain management in microtia patients. The nerve at the rib harvesting site regenerates within six months, without causing additional pain. We observed no adverse effects from the procedure."

In an ongoing study, Drs. Yamada and Rajeswaran will compare outcomes of microtia repair with the nerve freezing procedure and without. They will evaluate opioid use, length of hospital stays and functional recovery. This study is expected to be completed by the end of the year.