Pain management following the Nuss procedure: a survey of practice and review.

Abstract

Pectus excavatum is the most common congenital chest wall deformity. The Nuss procedure is frequently used for surgical correction and this technique has been associated with severe and prolonged post-operative pain. At the present time, the optimal analgesic strategy for managing patients following this procedure has not been determined. A web-based survey was sent to representatives from 108 primarily pediatric hospitals in North America, Europe, Asia and Australia. One individual per institution was contacted to complete the survey on behalf of their department. Survey response rate was 54% and 55 institutions reported using the Nuss procedure for correction of pectus excavatum. Annual case volume is less than or equal to 25 cases in 57% of institutions, and the most common age of patients is 14 to 17 years old. A clinical protocol for patient post-operative pain management is used in 45% of institutions. Thoracic epidural is utilized as a primary analgesic modality by 91% of institutions. Concomitant use of intravenous patient-controlled analgesia is reported by 27% of institutions. Nine respondents (16%) reported that they had recently stopped performing epidurals because of surgeon preference. Referral of one or more patients annually for chronic pain management was reported in 22% of surveys. Post-operative pain management following the Nuss procedure is variable and poorly characterized. Clinical trials or large observational registries comparing the safety and efficacy of primary modalities and long-term outcomes are needed to enable evidence-based decision-making for the management of these patients.