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Evolution of Pain Control for Adult Pectus Excavatum Repair.
Jaroszewski, Dawn E; Bostoros, Peter; Farina, Juan M; Botros, Michael M; Aly, Mohamed R; Peterson, Michelle; Lackey, Jesse; Pulivarthi, Krishna V; Smith, Bradford; Craner, Ryan; Stearns, Joshua D.
Afiliação
  • Jaroszewski DE; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona. Electronic address: jaroszewski.dawn@mayo.edu.
  • Bostoros P; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona.
  • Farina JM; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona.
  • Botros MM; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona.
  • Aly MR; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona.
  • Peterson M; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona.
  • Lackey J; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona.
  • Pulivarthi KV; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona.
  • Smith B; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona.
  • Craner R; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona.
  • Stearns JD; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona.
Ann Thorac Surg ; 117(4): 829-837, 2024 Apr.
Article em En | MEDLINE | ID: mdl-37279827
BACKGROUND: Pain control after minimally invasive repair of pectus excavatum (MIRPE) can be challenging, especially in adult patients undergoing surgical repair. This study reviewed different analgesic modalities used over ≥10 years after pectus repair. METHODS: A retrospective analysis was performed of adult patients (≥18 years) who underwent uncomplicated primary MIRPE at a single institution from October 2010 to December 2021. Patients were classified by analgesic modality used: epidural, elastomeric continuous infusion subcutaneous catheters (SC-Caths), and intercostal nerve cryoablation. Comparisons among the 3 groups were performed. RESULTS: In total, 729 patients were included (mean age, 30.9 ±10.3 years; 67% male; mean Haller index, 4.9 ±3.0). Patients in the cryoablation group required significantly lower doses of morphine equivalents (P < .001) and had overall the shortest hospital stay (mean, 1.9 ±1.5 days; P < .001) with <17% staying >2 days (vs epidural at 94% and SC-Cath at 48%; P < .001). The cryoablation group had a lower incidence of ileus and constipation (P < .001) but a higher incidence of pleural effusion requiring thoracentesis (P = .024). Mean pain scores among groups were minor (<3), and differences were insignificant. CONCLUSIONS: The use of cryoablation in conjunction with enhanced recovery pathways provided significant benefit to our patients undergoing MIRPE compared with previous analgesic modalities. These benefits included a decrease in length of hospital stay, a reduction of in-hospital opioid use, and a lower incidence of opioid-related complications associated with constipation and ileus. Further studies to assess additional potential benefits with long-term follow-up after discharge are warranted.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Íleus / Tórax em Funil Limite: Adult / Female / Humans / Male Idioma: En Revista: Ann Thorac Surg Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Íleus / Tórax em Funil Limite: Adult / Female / Humans / Male Idioma: En Revista: Ann Thorac Surg Ano de publicação: 2024 Tipo de documento: Article