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Pain and Anxiety Management in Minimally Invasive Repair of Pectus Excavatum

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초록

The Nuss procedure for the correction of Pectus Excavatum (PE) is associated with intense postoperative pain. Our strategy to control early postoperative pain is to combine epidural with intravenous analgesia. Our aim was to analyse our pain control strategy by reviewing all the PE cases treated at our institution. Sixty consecutive patients, aged between 12 and 26 years old, received the PE operation at our institution from January, 2007 to September, 2010. The median age was 16 (12−27) with a male/female ratio of about 7/1. An epidural catheter was employed in all the cases, with 38 patients (63%) requiring additional drugs to control pain, which remained in place for 74 hours (72−96). The pain score was higher in male patients, but lower in those younger than 16 years old. Moreover, patients that consumed benzodiazepines had a significant decrease in cumulative opioid intake (P = 0.0408). Both gender and age had an impact on pain control, while we noticed a synergistic effect between opiates and tranquillizers.

Abstract

The Nuss procedure for the correction of Pectus Excavatum (PE) is associated with intense postoperative pain. Our strategy to control early postoperative pain is to combine epidural with intravenous analgesia. Our aim was to analyse our pain control strategy by reviewing all the PE cases treated at our institution. Sixty consecutive patients, aged between 12 and 26 years old, received the PE operation at our institution from January, 2007 to September, 2010. The median age was 16 (12−27) with a male/female ratio of about 7/1. An epidural catheter was employed in all the cases, with 38 patients (63%) requiring additional drugs to control pain, which remained in place for 74 hours (72−96). The pain score was higher in male patients, but lower in those younger than 16 years old. Moreover, patients that consumed benzodiazepines had a significant decrease in cumulative opioid intake (P = 0.0408). Both gender and age had an impact on pain control, while we noticed a synergistic effect between opiates and tranquillizers.

참고문헌 (15)

  1. Grosen K, "Postoperative consumption of opioid analgesics following correction of pectus excavatum is influenced by pectus severity: a single-centre study of 236 patients undergoing minimally invasive correction of pectus excavatum", Eur J Cardiothorac Surg, 37, pp.833~839 (2010)
  2. Rugyte DC, "Systemic postoperative pain management following minimally invasive pectus excavatum repair in children and adolescents: a retrospective comparison of intravenous patient-controlled analgesia and continuous infusion with morphine", Pediatr Surg Int, 26, pp.665~669 (2010)
  3. St Peter SD, "Is epidural anesthesia truly the best pain management strategy after minimally invasive pectus excavatum repair?", J Pediatr Surg, 43, pp.79~82 (2008)
  4. Futagawa K, "Anesthetic management for the minimally invasive Nuss procedure in 21 patients with pectus excavatum", J Anesth, 20, pp.48~50 (2006)
  5. Weber T, "Superior postoperative pain relief with thoracic epidural analgesia versus intravenous patient- controlled analgesia after minimally invasive pectus excavatum repair", J Thorac Cardiovasc Surg, 134, pp.865~870 (2007)
  6. Soliman IE, "Intravenous versus epidural analgesia after surgical repair of pectus excavatum", Am J Ther, 16, pp.398~403 (2009)
  7. Cucchiaro G, "A comparison of epidural bupivacaine-fentanyl and bupivacaine-clonidine in children undergoing the Nuss procedure", Anesth Analg, 103, pp.322~327 (2006)
  8. Walaszczyk M, "Epidural and opioid analgesia following the Nuss procedure", Med Sci Monit, 17, pp.81~86 (2011)
  9. Densmore JC, "Initial surgical and pain management outcomes after Nuss procedure", J Pediatr Surg, 45, pp.1767~1771 (2010)
  10. Yapici D, "Morphine added to local anaesthetic improves epidural analgesia in minimally invasive Nuss operation for pectus excavatum", Br J Anaesth, 100, pp.280~ (2008)
  11. Al-Assiri A, "Operative innovation to the "Nuss" procedure for pectus excavatum: operative and functional effects", J Pediatr Surg, 44, pp.888~892 (2009)
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  13. Butkovic D, "Postoperative analgesia with intravenous fentanyl PCA vs epidural block after thoracoscopic pectus excavatum repair in children", Br J Anaesth, 98, pp.677~681 (2007)
  14. Cartoski MJ, "Classification of the dysmorphology of pectus excavatum", J Pediatr Surg, 41, pp.1573~1581 (2006)
  15. Ozalp G, "Preoperative emotional states in patients with breast cancer and postoperative pain", Acta Anaesthesiol Scand, 47, pp.26~29 (2003)

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