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Postoperative opioid analgesic use after Nuss versus Ravitch pectus excavatum repair

  • Jonathan C. Papic
    Affiliations
    Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA
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  • S. Maria E. Finnell
    Affiliations
    Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA

    Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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  • Abby M. Howenstein
    Affiliations
    Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA
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  • Francine Breckler
    Affiliations
    Department of Pharmacy, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
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  • Charles M. Leys
    Correspondence
    Corresponding author at: University of Wisconsin Medical School, H4/744 CSC, 600 Highland Ave, Madison, WI 53792, USA. Tel.: +1 608 263 9419; fax: +1 608 261 1876.
    Affiliations
    Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA
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      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

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