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Pain management for the Nuss procedure: comparison between erector spinae plane block, thoracic epidural, and control
OBJECTIVE: Pectus excavatum is a congenital deformity characterized by a caved-in chest wall. Repair requires surgery. The less invasive Nuss procedure is very successful, but postoperative pain management is challenging and evolving. New pain management techniques to reduce opioid reliance include...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9717353/ https://www.ncbi.nlm.nih.gov/pubmed/36474733 http://dx.doi.org/10.1136/wjps-2022-000418 |
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author | Santana, Lisgelia Driggers, John Carvalho, Norman F |
author_facet | Santana, Lisgelia Driggers, John Carvalho, Norman F |
author_sort | Santana, Lisgelia |
collection | PubMed |
description | OBJECTIVE: Pectus excavatum is a congenital deformity characterized by a caved-in chest wall. Repair requires surgery. The less invasive Nuss procedure is very successful, but postoperative pain management is challenging and evolving. New pain management techniques to reduce opioid reliance include the erector spinae plane (ESP) block. We retrospectively examined opioid consumption after Nuss procedure comparing three pain management techniques: ESP block, thoracic epidural (TE), and patient-controlled analgesia (PCA). METHODS: This retrospective cohort study compared pain management outcomes of three patient groups. Seventy-eight subjects aged 10–18 years underwent Nuss procedure at our institution between January 2014 and January 2020. The primary outcome measure was opioid consumption measured in morphine milligram equivalents. Secondary measures included pain ratings and length of stay (LOS). Pain was quantified using the Numeric Pain Rating Scale. Analysis of variance was performed on all outcome measures. RESULTS: Average cumulative opioid use was significantly lower in the ESP block (67 mg) than the TE (117 mg) (p=0.0002) or the PCA group (172 mg) (p=0.0002). The ESP block and PCA groups both had a significantly shorter average LOS (3.3 and 3.7 days, respectively) than the TE group (4.7 days). ESP block performed best for reducing opioid consumption and LOS. Reduced opioid consumption is key for limiting side effects. This study supports use of ESP block as a superior choice when choosing among the three postoperative pain management options that were evaluated. CONCLUSION: ESP resulted in reduced opioid consumption postoperatively and shorter LOS than TE or PCA for patients undergoing the Nuss procedure for surgical repair of pectus excavatum. |
format | Online Article Text |
id | pubmed-9717353 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-97173532022-12-05 Pain management for the Nuss procedure: comparison between erector spinae plane block, thoracic epidural, and control Santana, Lisgelia Driggers, John Carvalho, Norman F World J Pediatr Surg Original Research OBJECTIVE: Pectus excavatum is a congenital deformity characterized by a caved-in chest wall. Repair requires surgery. The less invasive Nuss procedure is very successful, but postoperative pain management is challenging and evolving. New pain management techniques to reduce opioid reliance include the erector spinae plane (ESP) block. We retrospectively examined opioid consumption after Nuss procedure comparing three pain management techniques: ESP block, thoracic epidural (TE), and patient-controlled analgesia (PCA). METHODS: This retrospective cohort study compared pain management outcomes of three patient groups. Seventy-eight subjects aged 10–18 years underwent Nuss procedure at our institution between January 2014 and January 2020. The primary outcome measure was opioid consumption measured in morphine milligram equivalents. Secondary measures included pain ratings and length of stay (LOS). Pain was quantified using the Numeric Pain Rating Scale. Analysis of variance was performed on all outcome measures. RESULTS: Average cumulative opioid use was significantly lower in the ESP block (67 mg) than the TE (117 mg) (p=0.0002) or the PCA group (172 mg) (p=0.0002). The ESP block and PCA groups both had a significantly shorter average LOS (3.3 and 3.7 days, respectively) than the TE group (4.7 days). ESP block performed best for reducing opioid consumption and LOS. Reduced opioid consumption is key for limiting side effects. This study supports use of ESP block as a superior choice when choosing among the three postoperative pain management options that were evaluated. CONCLUSION: ESP resulted in reduced opioid consumption postoperatively and shorter LOS than TE or PCA for patients undergoing the Nuss procedure for surgical repair of pectus excavatum. BMJ Publishing Group 2022-08-02 /pmc/articles/PMC9717353/ /pubmed/36474733 http://dx.doi.org/10.1136/wjps-2022-000418 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Original Research Santana, Lisgelia Driggers, John Carvalho, Norman F Pain management for the Nuss procedure: comparison between erector spinae plane block, thoracic epidural, and control |
title | Pain management for the Nuss procedure: comparison between erector spinae plane block, thoracic epidural, and control |
title_full | Pain management for the Nuss procedure: comparison between erector spinae plane block, thoracic epidural, and control |
title_fullStr | Pain management for the Nuss procedure: comparison between erector spinae plane block, thoracic epidural, and control |
title_full_unstemmed | Pain management for the Nuss procedure: comparison between erector spinae plane block, thoracic epidural, and control |
title_short | Pain management for the Nuss procedure: comparison between erector spinae plane block, thoracic epidural, and control |
title_sort | pain management for the nuss procedure: comparison between erector spinae plane block, thoracic epidural, and control |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9717353/ https://www.ncbi.nlm.nih.gov/pubmed/36474733 http://dx.doi.org/10.1136/wjps-2022-000418 |
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