Initial surgical and pain management outcomes after Nuss procedure

Densmore, John C.; Peterson, Danielle B.; Stahovic, Linda; Czarnecki, Michelle L.; Hainsworth, Keri R.; Davies, Hobart W.; Cassidy, Laura D.; Weisman, Steven J.; Oldham, Keith T.

doi:10.1016/j.jpedsurg.2010.01.028

Cited by 57 publications

(32 citation statements)

References 48 publications

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“…By protocol, patients were required to have 24 hours of documented, adequate pain score (≤4) on oral medications before they could be discharged. Pain and opiate use did not significantly increase in TEA group after catheter removal as has been reported by others (17,33) however in four patients, attempts to wean epidural dosing for removal resulted in inadequate analgesia with standard oral pain medication dosing and the epidural was left in for additional 24-48 hours. The optimal time to discontinue TEA is unknown.…”

Section: Mean Pain Scoresupporting

confidence: 72%

Randomized trial of epidural vs. subcutaneous catheters for managing pain after modified Nuss in adults

et al. 2016

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Background: Minimally invasive repair of pectus excavatum (MIRPE) is now performed in adults.Managing adult patients' pain postoperatively has been challenging due to increased chest wall rigidity and the pressure required for supporting the elevated sternum. The optimal pain management regimen has not been determined. We designed this prospective, randomized trial to compare postoperative pain management and outcomes between thoracic epidural analgesia (TEA) and bilateral subcutaneous infusion pump catheters (On-Q). Methods: Patients undergoing MIRPE (modified Nuss) underwent random assignment to TEA or On-Q group. Both groups received intravenous, patient-controlled opioid analgesia, with concomitant delivery of local anesthetic. Primary outcomes were length of stay (LOS), opioid use, and pain scores. Results: Of 85 randomly assigned patients, 68 completed the study [52 men, 76.5%; mean (range) age, 32.2 (20.0-58.0) years; Haller index, 5.9 (range, 3.0-26.7)]. The groups were equally matched for preoperative variables; however, the On-Q arm had more patients (60.3%). No significant differences were found between groups in mean daily pain scores (P=0.52), morphine-equivalent opioid usage (P=0.28), or hospital stay 3.5 vs. 3.3 days (TEA vs. On-Q; P=0.55). Thirteen patients randomized to TEA refused the epidural and withdrew from the study because they perceived greater benefit of the On-Q system.Conclusions: Postoperative pain management in adults after MIRPE can be difficult. Both continuous local anesthetic delivery by TEA and On-Q catheters with concomitant, intravenous, patient-controlled anesthesia maintained acceptable analgesia with a reasonable LOS. In our cohort, there was preference for the On-Q system for pain management.

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Section: Mean Pain Scoresupporting

confidence: 72%

Randomized trial of epidural vs. subcutaneous catheters for managing pain after modified Nuss in adults

et al. 2016

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“…The procedure is associated with significant post-operative pain, far greater than that reported with sternotomy or thoracotomy, which is arguably best treated with thoracic epidural analgesia. [9] Although less invasive than a traditional pacemaker dependent". He was otherwise healthy without comorbidity; complaining only of dyspnea with exertion, and on no home medications.…”

Section: Introductionmentioning

confidence: 99%

Emergent cardiopulmonary bypass during pectus excavatum repair

2013

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Pectus excavatum is a chest wall deformity that produces significant cardiopulmonary disability and is typically seen in younger patients. Minimally invasive repair of pectus excavatum or Nuss procedure has become a widely accepted technique for adult and pediatric patients. Although it is carried out through a thoracoscopic approach, the procedure is associated with a number of potential intraoperative and post-operative complications. We present a case of cardiac perforation requiring emergent cardiopulmonary bypass in a 29-year-old male with Marfan syndrome and previous mitral valve repair undergoing a Nuss procedure for pectus excavatum. This case illustrates the importance of vigilance and preparation by the surgeons, anesthesia providers as well as the institution to be prepared with resources to handle the possible complications. This includes available cardiac surgical backup, perfusionist support and adequate blood product availability.

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“…The available literature suggests that a thoracic epidural (EPI) catheter is the most effective means for attenuating the pain during the first few postoperative days [1][2][3][4][5][6]. Moreover, many centers exclusively manage patients undergoing bar placement with a thoracic EPI [7][8][9][10][11][12].…”

mentioning

confidence: 99%