Nerve freezing technique reduces pain after surgical repair of microtia.

Ann & Robert H. Lurie Children’s Hospital of Chicago is the first hospital in the world to end months of pain after surgical repair of microtia — a rare condition where a baby is born with an underdeveloped or missing outer ear. Previously, children suffering from microtia had to face long-term pain after operations because cartilage was taken out from one of their ribs to reconstruct the ear. Now, before plastic surgery, experts at Lurie Children’s freeze the nerve at the rib harvest site through a minimally invasive, ultrasound-guided procedure that lasts only 20 minutes. Patients can go home without pain a day after surgery.

The first three patients experiencing this unprecedented approach were recently reported Plastic and Reconstructive SurgeryJournal of the American Society of Plastic Surgeons. Currently, more than 30 patients have benefited from this method of pain control, with reduced opioid use and shorter hospital stays.

Severe pain after rib cutting was a major challenge in the Microtia repair which uses the patient’s own tissue to reconstruct the ear. Remarkably, pain is no longer a concern during recovery, so the opioids are mostly phased out and children go home early. It’s monumental.”

Akira Yamada, MD, PhD, senior author, plastic surgeon at Lurie Children’s and professor of pediatrics and plastic surgery at Northwestern University Feinberg School of Medicine

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

“Our innovation removes the pain barrier from natural ear reconstruction,” said co-author Shankar Rajeswaran, MD, division chief of interventional radiology at Lurie Children’s and associate professor of radiology at Northwestern University Feinberg School of Medicine. “This is a paradigm shift in how we manage pain in microtia patients. The nerve at the rib harvesting site regenerates within six months without causing additional pain. We saw no adverse effects from the procedure.”

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