Double-bar application decreases postoperative pain after the Nuss procedure

Abstract

Performing double-bar placement decreases postoperative pain. Therefore, surgeons should not hesitate to perform double-bar correction in patients in whom the deformity extends to multiple intercostal spaces, requiring correction of the thorax shape at multiple sites.

Contemporary management of recurrent pectus excavatum

“…Although the cause of this complication is not completely clear, progressive decrease of the intensity of the elevating forces transmitted to the superior thoracic cage could be a possible explanation. Biomechanical studies have been demonstrated that, with the application of a single bar, far greater stress is exerted on the rib supporting the bar (2.10 kg/mm 2 on the fifth rib) with intensity progressively decreasing on ribs superiorly (0.86 kg/ mm 2 on the second rib) [26,27]. In a rigid thorax, strong mechanical forces are directed posteriorly, opposing that of the bar [28].…”

Indications and guidelines for pectus excavatum repair

“…Reduced bar displacement has likely also resulted from utilization of multiple bar placement in more complex pectus excavatum patients [1 ,3 ,7], including those with stiff chest walls, severe asymmetry, or Marfan syndrome [26]. Multiple bar placement is theorized to allow wider distribution of the force necessary to elevate the sternal depression to the surrounding sternum, ribs, and costal cartilages and has been associated with less postoperative pain [27]. Asymmetric bar bending has been advocated for pectus excavatum patients with asymmetry and adult patients, but this technique has not been widely adopted [28].…”

Epidural and opioid analgesia following the Nuss procedure

“…Thoracic surgery is exceptionally painful [4,6,7,12]. The Nuss procedure is not a classic thoracotomy; however the severity of postoperative pain is comparable to open thoracotomy.…”

“…The bar is then reversed, and the sternum restored to the normal anatomical position [1]. Protopapas and Athanasiou, who recently assessed all the available data of 1,949 children who underwent the Nuss operation, revealed that although the operation has a zero mortality rate and very few complications, it is considered to be as painful as open thoracotomy [4,6,7]. The pain is located mainly in the anterior part of the thorax and the use of a double-bar (instead of just 1) tends to decrease the pain [7].…”