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Fiorelli S, Menna C, Andreetti C, Peritore V, Rocco M, De Blasi RA, Rendina EA, Massullo D, Ibrahim M. Bilateral Ultrasound-Guided Erector Spinae Plane Block for Pectus Excavatum Surgery: A Retrospective Propensity-Score Study. J Cardiothorac Vasc Anesth 2022; 36:4327-4332. [PMID: 36163156 DOI: 10.1053/j.jvca.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Pectus excavatum (PE) repair is burdened by severe postoperative pain. This retrospective study aimed to determine whether the analgesic effect of ultrasound-guided erector spinae plane block (ESPB) plus standard intravenous analgesia (SIVA) might be superior to SIVA alone in pain control after PE surgical repair via Ravitch or Nuss technique. DESIGN A retrospective cohort study. SETTING At a university hospital. PARTICIPANTS All participants were scheduled for surgical repair of PE. INTERVENTIONS From January 2017 to December 2019, all patients who received ESPB plus SIVA or SIVA alone were investigated retrospectively. A 2:1 propensity-score matching analysis considering preoperative variables was used to compare analgesia efficacy in 2 groups. All patients received a 24-hour continuous infusion of tramadol, 0.1 mg/kg/h, and ketorolac, 0.05 mg/kg/h, via elastomeric pump, and morphine, 2 mg, intravenously as a rescue drug. The ESPB group received preoperative bilateral ESPB block. Postoperative pain, reported using a numerical rating scale at 1, 12, 24, and 48 hours after surgery; the number of required rescue doses; total postoperative morphine milligram equivalents consumption; and the incidence of postoperative nausea and vomit were analyzed. MEASUREMENT AND MAIN RESULTS A total of 105 patients were identified for analysis. Propensity-score matching resulted in 38 patients in the SIVA group and 19 patients in the ESPB group. Postoperative pain, the number of rescue doses, and postoperative nausea and vomit incidences were lower in the ESPB group (p < 0.005). CONCLUSIONS Erector spinae plane block may be an effective option for pain management after surgical repair of PE as part of a multimodal approach. This study showed good perioperative analgesia, opioid sparing, and reduced opioid-related adverse effects.
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Affiliation(s)
- Silvia Fiorelli
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Cecilia Menna
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Claudio Andreetti
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Valentina Peritore
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Monica Rocco
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Roberto Alberto De Blasi
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Erino Angelo Rendina
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Domenico Massullo
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mohsen Ibrahim
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Manworren RC, Anderson MN, Girard ED, Ruscher KA, Verissimo AM, Palac H, Weiss R, Rader C, Hight D. Postoperative Pain Outcomes After Nuss Procedures: Comparison of Epidural Analgesia, Continuous Infusion of Local Anesthetic, and Preoperative Self-Hypnosis Training. J Laparoendosc Adv Surg Tech A 2018; 28:1234-1242. [DOI: 10.1089/lap.2017.0699] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Renee C.B. Manworren
- Department of Nursing, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew N. Anderson
- Department of Neurosurgery, Rhode Island Hospital, Brown University, Providence, Rhode Island
| | - Eric D. Girard
- Department of Surgery, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Kimberly A. Ruscher
- Department of Pediatric Surgery, Sacred Heart at Riverbend, Springfield, Oregon
| | - Ana Maria Verissimo
- Department of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, Connecticut
- Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Hannah Palac
- Department of Preventive Medicine, Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Center for Behavorial Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard Weiss
- Department of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, Connecticut
- Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Christine Rader
- Department of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, Connecticut
- Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Donald Hight
- Department of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, Connecticut
- Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut
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Patvardhan C, Martinez G. Anaesthetic considerations for pectus repair surgery. J Vis Surg 2016; 2:76. [PMID: 29078504 DOI: 10.21037/jovs.2016.02.31] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/04/2016] [Indexed: 11/06/2022]
Abstract
Repair of pectus is one of the most common congenital abnormality for which patient presents for thoracic surgery. In recent years, innovative minimally invasive techniques involving video assisted thoracoscopy for pectus repair have become the norm. Similarly, anaesthetic techniques have evolved to include principles of enhanced recovery, multimodal analgesia and innovative ultrasound guided neuraxial and nerve blocks. Adequate anaesthetic set up and monitoring including the use of real time intraoperative monitoring with transesophageal echocardiography (TOE) has enabled the anaesthetist to enhance patient safety by providing instantaneous imaging of cardiac compression and complications during surgery. In this review article we aim to provide non-systematic review and institutional experience of our anaesthetic strategy to provide effective peri-operative care in this patient group.
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Affiliation(s)
- Chinmay Patvardhan
- Department of Anaesthesia and Intensive Care, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Guillermo Martinez
- Department of Anaesthesia and Intensive Care, Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Li G, Jiang Z, Xiao H, Wang M, Hu F, Xie X, Mei J. A novel modified Nuss procedure for pectus excavatum: a new steel bar. Ann Thorac Surg 2015; 99:1788-92. [PMID: 25952207 DOI: 10.1016/j.athoracsur.2014.12.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 12/06/2014] [Accepted: 12/16/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this article is to introduce a new modified Nuss procedure for pectus excavatum and to describe the configuration of the new steel bar. DESCRIPTION We applied a novel method with a new steel bar for minimally invasive surgical correction of pectus excavatum. The procedure was performed with a new steel bar through bilateral thoracic minimally invasive incisions using a thoracoscope for guidance. The bar was installed or removed by pushing and pulling without turning it over. EVALUATION One hundred forty-seven patients with pectus excavatum underwent this novel modified Nuss procedure. All patients had a satisfactory orthopedic result at discharge. There was no perioperative death or cardiac perforation. During the follow-up period, 134 patients underwent bar removal. Of the 134 cases, the initial orthopedic and functional results were excellent in 121 patients (90.3%) and good in 13 patients (9.7%). No patient had recurrence. CONCLUSIONS This novel modified Nuss procedure is a safe, effective, and convenient treatment for pectus excavatum.
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Affiliation(s)
- Guoqing Li
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhaolei Jiang
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haibo Xiao
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mingsong Wang
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fengqing Hu
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiao Xie
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ju Mei
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Araújo MEDA, Penha ADP, Westphal FL, Silva MT, Galvão TF. Nuss procedure for pectus excavatum repair: critical appraisal of the evidence. Rev Col Bras Cir 2015; 41:400-5. [PMID: 25742405 DOI: 10.1590/0100-69912014006004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/28/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness and safety of correction of pectus excavatum by the Nuss technique based on the available scientific evidence. METHODS We conducted an evidence synthesis following systematic processes of search, selection, extraction and critical appraisal. Outcomes were classified by importance and had their quality assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS The process of selection of items led to the inclusion of only one systematic review, which synthesized the results of nine observational studies comparing the Nuss and Ravitch procedures. The evidence found was rated as poor and very poor quality. The Nuss procedure has increased the incidence of hemothorax (RR = 5.15; 95% CI: 1.07; 24.89), pneumothorax (RR = 5.26; 95% CI: 1.55; 17.92) and the need for reintervention (RR = 4.88; 95% CI: 2.41; 9.88) when compared to the Ravitch. There was no statistical difference between the two procedures in outcomes: general complications, blood transfusion, hospital stay and time to ambulation. The Nuss operation was faster than the Ravitch (mean difference [MD] = -69.94 minutes, 95% CI: -139.04, -0.83). CONCLUSION In the absence of well-designed prospective studies to clarify the evidence, especially in terms of aesthetics and quality of life, surgical indication should be individualized and the choice of the technique based on patient preference and experience of the team.
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Affiliation(s)
| | | | | | | | - Taís Freire Galvão
- Getúlio Vargas University Hospital, Federal University of Amazonas, AM, Brazil
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Walaszczyk M, Knapik P, Misiolek H, Korlacki W. Epidural and opioid analgesia following the Nuss procedure. Med Sci Monit 2012; 17:PH81-86. [PMID: 22037752 PMCID: PMC3539505 DOI: 10.12659/msm.882032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Parents have the right to decide on behalf of their children and deny consent to regional anaesthesia. The investigators decided to investigate quality of postoperative analgesia in adolescents undergoing epidural and opioid analgesia following the Nuss procedure. Material/Methods The study subjects were 61 adolescents aged 11–18 years who underwent pectus excavatum repair with the Nuss procedure. Patients were divided into epidural (n=41) and opioid (n=20) groups, depending on their parents’ consent to epidural catheter insertion. Intraoperatively, 0.5% epidural ropivacaine with fentanyl or intermittent intravenous injections of fentanyl were used. Postoperative analgesia was achieved with either epidural infusion of 0.1% ropivacaine with fentanyl, or subcutaneous morphine via an intraoperatively inserted “butterfly” cannula. Additionally, both groups received metamizol and paracetamol. Primary outcome variables were postoperative pain scores (Numeric Rating Scale and Prince Henry Hospital Pain Score). Secondary outcome variables included hemodynamic parameters, additional analgesia and side effects. Results Heart rate and blood pressure values in the postoperative period were significantly higher in the opioid group. Pain scores requiring intervention were noted almost exclusively in the opioid group. Conclusions Denial of parental consent to epidural analgesia following the Nuss procedure results in significantly worse control of postoperative pain. Our data may be useful when discussing with parents the available anaesthetic techniques for exceptionally painful procedures.
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Affiliation(s)
- Malgorzata Walaszczyk
- University Department of Anesthesiology and Intensive Therapy, Medical University of Silesia, Zabrze, Poland
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