Same day discharge for pectus excavatum—is it possible?

Rettig, R. Luke; Rudikoff, Andrew G.; Lo, Hoi Yee Annie; Lee, Constance W.; Vazquez, W. David; Rodríguez, Karen M. Peña; Shaul, Donald B.; Conte, Antonio Hernandez; Banzali, Franklin M.; Sydorak, Roman M.

doi:10.1016/j.jpedsurg.2021.02.007

Cited by 11 publications

(11 citation statements)

References 19 publications

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“…29 Our idea is to go a step further and eliminate PCA from the postoperative protocol in patients with CPr, to verify the decrease in adverse effects of opioids, reduction of hospital stay and, therefore, hospital costs. This idea is in line with the protocols established by Rettig et al or Di Fiore et al 30,31 Finally, percutaneous ultrasound-guided cryoanalgesia (PCr) contributes to the acquisition of skills for its potential use in other pediatric surgical interventions requiring short-and longterm pain control (painful burns of long evolution, rib fractures, palliative process, and lung transplantation...). 14,15,[32][33][34][35][36][37][38][39][40] The main limitation of our study was the small sample size, especially in the PCr24 group.…”

Section: Discussionmentioning

confidence: 69%

Ultrasound-Guided Percutaneous Cryoanalgesia for Pectus Excavatum: When Should It be Applied?

et al. 2022

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Introduction The addition of ultrasound-guided percutaneous cryoanalgesia (PCr) for pain management after pectus excavatum (PE) surgery offers a new and advantageous approach. Our aim is to describe our experience with PCr applied on the same day, 24 hours, and 48 hours prior to PE surgery. Material and Methods Prospective pilot study in patients undergoing ultrasound-guided PCr (2019–2022) was divided into three groups: PCr on the same day of surgery (PCrSD), PCr 24 hours before (PCr24), and PCr 48 hours before (PCr48). We describe the application of technique and data obtained by comparing the three groups. Results We present 42 patients (25 PCrSD, 11 PCr24, 6 PCr48). PCr24 had a shorter procedure duration than PCrSD (65.8 vs. 91.2 minute; p = 0.048). Related to analgesia, PCr24 and PCr48 showed lower opioid consumption than PCrSD in PCA volume (48.5 and 49.6 vs. 75.1 mL; p = 0.015) and PCA time (23.3 and 23.8 vs. 34.3 hours; p = 0.01). Degree of pain (VAS scale) on the day of surgery and on the second postoperative day was lower in PCr24 and PCr48 than in PCrSD (4 and 2 vs. 5; p = 0.012; 0 and 1 vs. 2; p = 0.01, respectively) as well as shorter hospital stay (3 and 3.5 vs. 5 days; p = 0.021). In addition, PCr24 showed lower opioid consumption and hospital stay than PCr48 (p > 0.05). The greatest savings in hospital costs were obtained in the PCr24 group. Conclusion PCr48 and PCr24 prior to PE surgery offers lower opioid consumption, less pain and shorter hospital stay than PCrSD. PCr24 is comparable to PCr48, but seems to show advantages and simpler logistics for the patient and the hospital.

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Section: Discussionmentioning

confidence: 69%

Ultrasound-Guided Percutaneous Cryoanalgesia for Pectus Excavatum: When Should It be Applied?

et al. 2022

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“…Graves et al found that in comparison to thoracic epidural analgesia, patients undergoing cryoanalgesia had a significantly decreased opioid requirement while inpatient, and length of stay was decreased from 5 to 3 days in the INC group (14). In a small study by Rettig et al same-day discharge was possible for 66.7% of patients who underwent a combination of INC and intercostal nerve block (15). This modality certainly shows promise, though Sun et al noted an increased rate of slipped bars requiring reoperation among patients undergoing INC [OR 36.65 (5.04-266.39)] ( 16).…”

Section: Discussionmentioning

confidence: 99%

“…There is a growing interest in the role of loco-regional anesthesia as an adjunct to a multimodal perioperative pain control strategy for the Nuss procedure. Methods previously investigated include paravertebral blocks (11), intercostal rib blocks with short-acting local anesthetic (12,13), and intercostal nerve cryoablation (INC) (14)(15)(16)(17)(18). However, there is very little published in the literature with regards to the use of long-acting local anesthetic for rib blocks during this procedure in the adolescent population.…”

Section: Introductionmentioning

confidence: 99%

A multimodal protocol utilizing liposomal bupivacaine rib blocks leads to opioid reduction in patients undergoing the Nuss procedure

Eubanks¹,

Grabski²,

Pollack³

et al. 2021

J Thorac Dis

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“…The substantial improvements in pain management, with the possibility of same-day discharge, and substantially decreased opioid usage reported here are critical to optimizing the core component of ERAS guidelines. Rettig et al recently investigated the effect of intraoperative intercostal nerve block injection on same-day discharge after the Nuss procedure [ 28 , 29 ]. They reported same-day discharge without subsequent complications in 10 of 15 patients, which is similar to the rate observed in our study population.…”

Section: Discussionmentioning

confidence: 99%

A pilot study of multi-modal pain management for same-day discharge after minimally invasive repair of pectus excavatum (Nuss procedure) in children

et al. 2023

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Background Despite advancements in minimally invasive repair of pectus excavatum (MIRPE), Nuss procedure, postoperative pain control remains challenging. This report covers a multimodal regimen using bilateral single-shot paravertebral block (PVB) and bilateral thoracoscopic intercostal nerve (T3–T7) cryoablation, leading to significant reduction in length of stay (LOS) and high rate of same-day discharge. Methods This is a comparative study of pain management protocols for patients undergoing the Nuss procedure at a single center from 2016 through 2020. All patients underwent the the same surgical technique for the treatment of pectus excavatum at a single center. Patients received bilateral PVB with continuous infusion (Group 1, n = 12), bilateral PVB with infusion and right-side cryoablation (Group 2, n = 9), or bilateral single-shot PVB and bilateral cryoablation (Group 3, n = 17). The primary outcome was LOS with focus on same-day discharge, and the secondary outcome was decreased opioid usage. Results Eleven of 17 patients in Group 3 (65%) (bilateral single-shot PVB and bilateral cryoablation) were discharged the same day as surgery. The remaining Group 3 patients were discharged the following day with no complications or interventions. Compared to Group 1 (no cryoablation), Group 3 had shorter LOS (median 4.4 days vs. 0.7 days, respectively, p < 0.001) and significantly decreased median opioid use on the day of surgery (0.92 mg/kg vs. 0.47 mg/kg, p = 0.006). Conclusion Findings demonstrate the feasibility of multimodal pain management for same-day discharge after the Nuss procedure. Future multisite studies are needed to investigate the superiority of this approach to established methods. Level of Evidence III.

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Same day discharge for pectus excavatum—is it possible?

Cited by 11 publications

References 19 publications

Ultrasound-Guided Percutaneous Cryoanalgesia for Pectus Excavatum: When Should It be Applied?

Ultrasound-Guided Percutaneous Cryoanalgesia for Pectus Excavatum: When Should It be Applied?

A multimodal protocol utilizing liposomal bupivacaine rib blocks leads to opioid reduction in patients undergoing the Nuss procedure

A pilot study of multi-modal pain management for same-day discharge after minimally invasive repair of pectus excavatum (Nuss procedure) in children

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