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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Article Info
Publication History
Accepted:
January 27,
2014
Received:
January 14,
2014
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
