Patient-controlled analgesia-based pain control strategy for minimally-invasive pectus excavatum repair

Abstract

Aim The minimally-invasive Nuss procedure has become the preferred technique for pectus excavatum repair. This procedure is still associated with significant postoperative pain, and an optimal pain-management strategy is yet to be determined. The purpose of this study was to compare the efficacy of patient-controlled analgesia (PCA) to thoracic epidural analgesia (TEA). Patients and Methods We retrospectively reviewed 112 charts from a single paediatric centre. Patients were grouped according to pain-management strategy: 90 patients received a PCA, and 22 patients received TEA. Outcomes included length of hospitalization and daily pain scores, operating room time and duration of Foley catheterization. Results Demographic data were similar between the two groups. The daily pain scores were not statistically different between the groups. Length of hospitalization was similar (PCA: 4.6 days, epidural: 4.3 days, P = 0.33). The PCA group required less operating room time (2:44 vs 2:58, P = 0.04) and shorter Foley catheter duration (2.1 days vs 2.5 days, P = 0.04). Conclusion In our patient population, TEA for the Nuss procedure does not offer an advantage over PCA-centred analgesia in terms of subjective daily pain scores or length of hospital stay. The potential risks of TEA need to be carefully considered in this patient population.