A retrospective comparison of thoracic epidural infusion and multimodal analgesia protocol for pain management following the minimally invasive repair of pectus excavatum
| Autor: | Theresa J. DiMaggio, Scott R. Dubow, Janice Y. Man, N. Scott Adzick, Harshad Gurnaney, Wallis T. Muhly, Gina R. Kroeplin |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Analgesic Thoracic Vertebrae Cohort Studies 03 medical and health sciences 0302 clinical medicine Pectus excavatum 030202 anesthesiology 030225 pediatrics medicine Humans Minimally Invasive Surgical Procedures Pain Management Pain Measurement Retrospective Studies Pain Postoperative business.industry Analgesia Patient-Controlled Retrospective cohort study Perioperative Analgesics Non-Narcotic Length of Stay medicine.disease Confidence interval Surgery Analgesia Epidural Analgesics Opioid Treatment Outcome Anesthesiology and Pain Medicine Opioid Funnel Chest Anesthesia Pediatrics Perinatology and Child Health Cohort Morphine Female business medicine.drug |
| Zdroj: | Pediatric Anesthesia. 27:1227-1234 |
| ISSN: | 1155-5645 |
| DOI: | 10.1111/pan.13264 |
| Popis: | SummaryBackground Pain management following minimally invasive repair of pectus excavatum is variable. We recently adopted a comprehensive multimodal analgesic protocol that standardizes perioperative analgesic management. We hypothesized that patients managed with this protocol would use more opioids postoperatively, have similar pain control, and shorter length of stay compared to patients managed with thoracic epidural infusion. Aims We retrospectively compared opioid consumption, pain scores, and length of stay between a cohort of patients managed with our multimodal analgesic protocol and a cohort managed with a thoracic epidural infusion. Methods This retrospective cohort comparison includes patients, 8 to 21 years of age, managed with either thoracic epidural infusion (n = 21) or multimodal analgesic protocol (n = 29) following minimally invasive repair of pectus excavatum from January 1, 2011 through September 15, 2015. The primary outcome, total daily opioid consumption in morphine equivalents, is presented as an average by postoperative day. Secondary outcomes included median daily pain score and length of stay. Results Patients were similar in age, weight, sex, and physical status. Patients managed with thoracic epidural infusion received less opioid (morphine equivalents—mg/kg) intraoperatively compared to multimodal analgesic protocol (difference of mean [95% confidence interval] 0.22 [0.16-0.28] P ≤ .01) but required more total opioid through postoperative day 3 (difference of mean [95% confidence interval] 1.2 [0.26-2.14] P = .01). We did not observe a difference in pain scores. Median length of stay was 1 day less in patients managed with multimodal analgesic protocol (difference of median [95% confidence interval] 1 [0.3-1.7] P = .003). Conclusion Implementation of a standardized comprehensive multimodal analgesic protocol following minimally invasive repair of pectus excavatum resulted in equivalent analgesia with a modest reduction in length of stay when compared to thoracic epidural. We did not observe an opioid sparing effect in our thoracic epidural which may reflect technique variability. |
| Databáze: | OpenAIRE |
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