Is epidural anesthesia truly the best pain management strategy after minimally invasive pectus excavatum repair?

Journal of Pediatric Surgery
Shawn D St PeterGeorge W Holcomb

Abstract

The repair of pectus excavatum with bar placement is associated with substantial postoperative pain. Optimal pain control strategy has not been addressed with level 1 or substantial level 2 evidence. Many institutions operate under the assumption that a thoracic epidural offers the best pain control for these patients. Therefore, we conducted a retrospective evaluation to examine the validity of this assumption. A retrospective review of patients undergoing pectus excavatum repair with bar placement from January 2000 to February 2006 was conducted. The demographic variables collected included age, sex, weight, and Haller's index scores. Outcome variables included total operating room time, number of calls to the anesthesiologist, hours of urinary catheterization, hours until complete transition to oral pain medication, length of hospitalization, and maximum pain scores for each of the first 5 postoperative days. There were a total of 203 patients, of which 188 had an epidural, compared with 15 with intravenous narcotic therapy. Of the 188 patients committed to an epidural, 65 had a failed attempt in the operating room or a dysfunctional catheter removed within 24 hours. Patients without an epidural had a shorter operating room ...Continue Reading

References

Feb 15, 2001·Journal of Pediatric Surgery·K A MolikJ L Grosfeld
Jan 25, 2002·AORN Journal·B SwovelandD Nuss
Apr 26, 2003·World Journal of Surgery·Eric W Fonkalsrud
Jan 17, 2004·The Annals of Thoracic Surgery·Hyung Joo ParkKihl Roh Lee
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Citations

Mar 6, 2009·American Journal of Therapeutics·Iris E SolimanJoseph D Tobias
Feb 5, 2014·Anesthesiology Clinics·Jagroop Mavi, David L Moore
Nov 19, 2015·Journal of Pediatric Surgery·Patrick D LoftusRebecka L Meyers
Sep 21, 2010·Journal of Pediatric Surgery·John C DensmoreKeith T Oldham
Aug 5, 2014·Acta Anaesthesiologica Scandinavica·W T MuhlyJ P Cravero
Jun 22, 2018·Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a·Joseph SujkaShawn D St Peter
Sep 27, 2018·Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a·Shefali ThakerMeghna V Misra
Oct 24, 2012·The Korean Journal of Pain·Marco GhionzoliAndrea Messeri
Nov 20, 2019·Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a·Gulcin AydinUnase Buyukkocak
Apr 3, 2018·Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a·Renee C B ManworrenDonald Hight
Apr 20, 2018·Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a·Nicole MorikawaDevin Puapong
Oct 11, 2019·European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [et Al] = Zeitschrift Für Kinderchirurgie·Joseph A SujkaShawn D St Peter
Nov 20, 2020·Pediatric Surgery International·R Luke RettigRoman M Sydorak

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