Abstract
Background/Purpose
Anticipated postoperative pain may affect procedure choice in patients with pectus
excavatum. This study aims to compare postoperative pain in patients undergoing Nuss
and Ravitch procedures.
Methods
A 5 year retrospective review was performed. Data on age, gender, Haller index, procedure,
pain scores, pain medications, and length of hospital stay were collected. Total inpatient
opioid administration was converted to morphine equivalent daily dose per kilogram
(MEDD/kg) and compared between procedures.
Results
One hundred eighty-one patients underwent 125 (69%) Nuss and 56 (31%) Ravitch procedures.
Ravitch patients were older (15.7 yo vs 14.6 yo, p = 0.004) and had a higher Haller index (5.21 vs 4.10, p = <0.001). Nuss patients had higher average daily pain scores, received 25% more opioids
(MEDD/kg 0.66 vs. 0.49, p = <0.001), and received twice as much IV diazepam/kg. In the multivariate analysis, higher
MEDD/kg correlated with both the Nuss procedure and older age in the Nuss group. Opioid
administration did not correlate with Haller index or Nuss bar fixation technique.
Increased NSAID administration did not correlate with lower use of opioids.
Conclusion
The Nuss procedure is associated with greater postoperative pain compared to the Ravitch
procedure. Opioid use is higher in older patients undergoing the Nuss procedure, but
is not associated with severity of deformity.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Factors affecting risks of congenital malformations. I. Analysis of epidemiologic factorsin congenital malformations. Reprot from the Collaborative Perinatal Project.Birth Defects Orig Artic Ser. 1975; 11: 1-22
- Surgical management of children and young adults with Marfan syndrome and pectus excavatum.J Pediatr Surg. 1988; 23: 1169-1172
- Chest wall deformities in pediatric surgery.Surg Clin North Am. 2012; 92 ([ix]): 669-684
- Quality-of-life outcomes after surgical correction of pectus excavatum: a comparison of the Ravitch and Nuss procedures.J Pediatr Surg. 2008; 43: 819-825
- A 10-year review of a minimally invasive technique for the correction of pectus excavatum.J Pediatr Surg. 1998; 33: 545-552
- Prospective multicenter study of surgical correction of pectus excavatum: design, perioperative complications, pain, and baseline pulmonary function facilitated by internet-based data collection.J Am Coll Surg. 2007; 205: 205-216
- Comparison of minimally invasive and modified Ravitch pectus excavatum repair.J Pediatr Surg. 2002; 37: 413-417
- Pectus excavatum repair: experience with standard and minimal invasive techniques.J Pediatr Surg. 2001; 36: 324-328
- Reduced hospitalization cost for patients with pectus excavatum treated using minimally invasive surgery.Surg Endosc. 2003; 17: 1609-1613
- Comparison of the Nuss and the Ravitch procedure for pectus excavatum repair: a meta-analysis.J Pediatr Surg. 2010; 45: 880-886
- Equianalgesic dose ratios for opioids. a critical review and proposals for long-term dosing.J Pain Symptom Manage. 2001; 22: 672-687
- Clinical pharmacology of opioids for pain.Clin J Pain. 2002; 18: S3-S13
- Opioids.Chapter 16. Clinical pain management: a practical guide. 2011: 130
- Pediatric minimally invasive surgery: laparoscopy and thoracoscopy in infants and children.Pediatrics. 2012; 130: 539-549
- Surgical treatment for pectus excavatum.J Korean Med Sci. 2003; 18: 360-364
- Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango).Soc Sci Med. 1997; 44: 681-692
- Force required to elevate the sternum of pectus excavatum patients.J Am Coll Surg. 2002; 195: 575-577
- How early can we repair pectus excavatum: the earlier the better?.Eur J Cardiothorac Surg. 2012; 42: 667-672
- Experience and modification update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients.J Pediatr Surg. 2002; 37: 437-445
- Minimally invasive surgical repair of pectus excavatum.Semin Pediatr Surg. 2008; 17: 209-217
- Early results following the Nuss operation for pectus excavatum — a single institution experience of 383 patients.Interact Cardiovasc Thorac Surg. 2008; 7: 54-57
- Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients.Ann Surg. 2010; 252: 1072-1081
- Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs for the reduction in morphine-related side-effects after major surgery: a systematic review.Br J Anaesth. 2011; 106: 292-297
- Evaluation of intravenous ketorolac administered by bolus or infusion for treatment of postoperative pain. A double-blind, placebo-controlled, multicenter study.Anesthesiology. 1994; 80: 1277-1286
- Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: a qualitative review.Br J Anaesth. 2002; 88: 199-214
- Intravenous ketoprofen as an adjunct to patient-controlled analgesia morphine in adolescents with thoracic surgery: a placebo controlled double-blinded study.Eur J Pain. 2007; 11: 694-699
Article info
Publication history
Accepted:
January 27,
2014
Received:
January 14,
2014
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
