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

Jaroszewski, Dawn E.; Temkit, Mʼhamed; Ewais, Mennat Allah M.; Luckritz, Todd; Stearns, Joshua D.; Craner, Ryan C.; Gaitan, Brantley Dollar; Ramakrishna, Harish; Thunberg, Christopher A.; Weis, Ricardo A.; Myers, Kelly M.; Merritt, Marianne V.; Rosenfeld, David M.

doi:10.21037/jtd.2016.06.62

Cited by 24 publications

(12 citation statements)

References 32 publications

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“…SCA patients had a higher opioid consumption on POD 1 and 2. These results are in concordance with current literature where slightly higher additional analgesic use is described in continuous local analgesia groups versus TEA-groups in thoracic surgery [15, 24]. However, the mean total opioid dose on the first and second POD (23.4 mg and 17.0 mg respectively) was in our opinion acceptable.…”

Section: Discussionsupporting

confidence: 92%

Subpleural multilevel intercostal continuous analgesia after thoracoscopic pulmonary resection: a pilot study

Bousema

Dias

Hagen

et al. 2019

J Cardiothorac Surg

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BackgroundSufficient pain control and rapid mobilisation after VATS are important to enhance recovery and prevent complications. Thoracic epidural analgesia (TEA) is the gold standard, but failure rates of 9–30% have been described. In addition, TEA reduces patient mobilisation and bladder function. Subpleural continuous analgesia (SCA) is a regional analgesic technique that is placed under direct thoracoscopic vision and is not associated with the mentioned disadvantages of TEA. The objective of this study was to assess surgical feasibility, pain control and patient satisfaction of SCA.MethodsObservational pilot study in patients who underwent VATS pulmonary resection and received SCA (n = 23). Pain scores (numeric rating scale 0–10) and patient satisfaction (5-point Likert scale) were collected on postoperative day (POD) 0–3. Secondary outcomes were the period of urinary catheter use and period to full mobilisation.ResultsPlacement of the subpleural catheter took an average of 11 min (SD 5) and was successful in all patients. Pain scores on POD 0–3 were 1.2 (SD 1.2), 2.0 (SD 1.9), 1.7 (SD 1.5) and 1.2 (SD 1.1) respectively. On POD 0–3 at least 79% of patients were satisfied or very satisfied on pain relief and mobilisation. The duration of subpleural continuous analgesia was 4 days (IQR 3–5, range 2–11). Urinary catheters were used zero days (IQR 0–1, range 0–6) and full mobilisation was achieved on POD 2 (IQR 1–2, range 1–6).ConclusionSubpleural continuous analgesia in VATS pulmonary resection is feasible and provides adequate pain control and good patient satisfaction.Trial registrationThis pilot study was not registered in a trial register.

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Section: Discussionsupporting

confidence: 92%

Subpleural multilevel intercostal continuous analgesia after thoracoscopic pulmonary resection: a pilot study

Bousema

Dias

Hagen

et al. 2019

J Cardiothorac Surg

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“…1,2 Severe postoperative pain is the most common complaint after the Nuss procedure, especially in adult patients whose chest wall is more rigid than younger patients. [3][4][5] Prolonged hospitalization for severe pain could further lead to increased medical expenses. Postoperative pain is usually managed with epidural analgesia or intravenous patient-controlled analgesia in the immediate postoperative period and with narcotics or NSAIDs afterward.…”

Section: Introductionmentioning

confidence: 99%

Extended pain relief achieved by analgesic-eluting biodegradable nanofibers in the Nuss procedure: in vitro and in vivo studies

Liu

Chen

Lee

et al. 2018

IJN

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BackgroundThe most common complaint after the Nuss procedure is severe postoperative chest pain. The aim of this study was to evaluate the effectiveness of analgesic-eluting biodegradable nanofibers in pain relief after the Nuss procedure.Materials and methodsPoly(d,l)-lactide-co-glycolide, lidocaine, and ketorolac were dissolved in 1,1,1,3,3,3-hexafluoro-2-propanol. This solution was electrospun into a nanofibrous membrane. The elution method and high-performance chromatography were used to characterize the in vitro drug release. Stainless steel bars with and without coating of the analgesic-eluting nanofibrous membrane were implanted underneath the sternums of New Zealand white rabbits. The in vivo characteristics were further investigated.ResultsThe in vitro study showed that the biodegradable nanofibers released high doses of lidocaine and ketorolac within 10 days. The in vivo study demonstrated high local and systemic concentrations of lidocaine and ketorolac. The serum creatinine level was unaffected. Animals that received implants of the analgesic-eluting nanofiber-coated stainless steel bar exhibited significantly greater food and water ingestion and physical activity than the control group did, indicating effective pain relief.ConclusionThe proposed analgesic-eluting biodegradable nanofibers contribute to the achievement of extended pain relief after the Nuss procedure, without obvious adverse effects, in an animal model.

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“…In the past 10 years, Nuss bar and traditional Nuss procedure have been used for correction of PE [9][10][11]. However, shortcoming of the bar and procedure was also found [12,13].…”

Section: Discussionmentioning

confidence: 99%

Modified Nuss Operation Using Introducer-Bar Complex for Pectus Excavatum in Adults: A Retrospective Study

Wang

Liu

et al. 2020

Preprint

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BackgroundShortcoming of traditional Nuss operation on adults is gradually found in the clinical practice. A new kind of introducer-bar complex was introduced. However, there is limited evidence regarding its safety and efficacy. Therefore, a single center, retrospective study was conducted to address this issue.MethodsPatients with pectus excavatum who underwent surgery between January 2015 and June 2017 were consecutively enrolled in this study. In all, 52 patients underwent the modified procedure using the introducer-bar complex (new procedure group), whereas 48 underwent the traditional anti-Nuss procedure (traditional procedure group). Outcomes analysis of balanced baseline was performed to compare the intraoperative and postoperative short-term outcomes.ResultsAll patients in the new procedure group had shorter operation duration (51.54 ± 20.32 vs. 79.45 ± 13.88 min, p = 0.017), postoperative hospitalizations (4.77 ± 1.62 vs. 6.86 ± 2.18 days, p = 0.028), plate removal surgery durations (39.30 ± 8.97 vs. 60.30±10.49 min, p < 0.001), and less blood loss during operation (6.25 ± 4.88 vs. 10.90±5.75ml, p = 0.003) than patients in the traditional procedure group. There was no significant difference in the length of incision, postoperative Haller index, cost, number of steel bars, postoperative surgical outcome and incidence of complications between the two groups.ConclusionThrough the main clinical outcome were similar, our data reveals modified procedure has shorter operation time, postoperative hospital stay, operation time for plate removal and less blood loss, which will bring potential clinical benefits to patients.

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

Cited by 24 publications

References 32 publications

Subpleural multilevel intercostal continuous analgesia after thoracoscopic pulmonary resection: a pilot study

Subpleural multilevel intercostal continuous analgesia after thoracoscopic pulmonary resection: a pilot study

Extended pain relief achieved by analgesic-eluting biodegradable nanofibers in the Nuss procedure: in vitro and in vivo studies

Modified Nuss Operation Using Introducer-Bar Complex for Pectus Excavatum in Adults: A Retrospective Study

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