Abstract
Introduction
Pectus excavatum and pectus carinatum are the most common chest wall deformities of
childhood. Surgical repair can be complicated by post-operative analgesic challenges.
Thoracic epidural analgesia, patient-controlled analgesia, and multimodal pain control
are among the most common strategies. We sought to define the current utilization
of intraoperative thoracic neurolysis, hypothesizing that this would minimize length
of stay (LOS) and post-operative narcotic use with relatively higher proportion of
non-narcotic post-operative analgesia.
Methods
We performed a retrospective review of the Pediatric Health Information System (PHIS)
database between 2017 and 2020. We first identified patients who underwent a pectus
repair via ICD-10-PCS codes. We used ICD-10-PCS codes 01580ZZ and 01584ZZ to identify
those patients who underwent concomitant thoracic neurolysis. Statistical analyses
were performed using R; p value less than 0.05 was considered significant.
Results
We identified 2979 patients who underwent a pectus repair. 184 underwent a concomitant
thoracic nerve destruction procedure (6.7%); 13 were performed in 2017 (2.01%), 76
in 2018 (10.7%), and 84 in 2019 (9.6%). LOS was shorter in those patients who underwent
neurolysis (mean=2.55 vs 3.73 days, SD=1.33 vs 1.78 days, p<0.001). There were fewer post-operative ICU admissions in neurolysis patients (3/184 vs.
193/2795, p = 0.003). The cost of procedures that included a neurolysis were higher, though not
significantly so (mean=$24,885.64 vs $22,200.59).
Conclusion
Thoracic neurolysis may be a useful analgesic strategy, expediating post-operative
discharge and potentially obviating the need for intensive care. Further larger-scale
prospective trials should be considered to further elucidate the role of this analgesia
method.
Level of Evidence
Level III
Keywords
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Article info
Publication history
Published online: February 19, 2022
Accepted:
February 14,
2022
Received in revised form:
February 11,
2022
Received:
September 4,
2021
Identification
Copyright
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