Postoperative opioid analgesic use after Nuss versus Ravitch pectus excavatum repair

Jonathan C. Papic, S. Maria Finnell, Abby M. Howenstein, Francine Breckler, Charles M. Leys

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background/Purpose Anticipated postoperative pain may affect procedure choice in patients with pectus excavatum. This study aims to compare postoperative pain in patients undergoing Nuss and Ravitch procedures. Methods A 5 year retrospective review was performed. Data on age, gender, Haller index, procedure, pain scores, pain medications, and length of hospital stay were collected. Total inpatient opioid administration was converted to morphine equivalent daily dose per kilogram (MEDD/kg) and compared between procedures. Results One hundred eighty-one patients underwent 125 (69%) Nuss and 56 (31%) Ravitch procedures. Ravitch patients were older (15.7 yo vs 14.6 yo, p = 0.004) and had a higher Haller index (5.21 vs 4.10, p = < 0.001). Nuss patients had higher average daily pain scores, received 25% more opioids (MEDD/kg 0.66 vs. 0.49, p = < 0.001), and received twice as much IV diazepam/kg. In the multivariate analysis, higher MEDD/kg correlated with both the Nuss procedure and older age in the Nuss group. Opioid administration did not correlate with Haller index or Nuss bar fixation technique. Increased NSAID administration did not correlate with lower use of opioids. Conclusion The Nuss procedure is associated with greater postoperative pain compared to the Ravitch procedure. Opioid use is higher in older patients undergoing the Nuss procedure, but is not associated with severity of deformity.

Original languageEnglish
Pages (from-to)919-923
Number of pages5
JournalJournal of Pediatric Surgery
Volume49
Issue number6
DOIs
StatePublished - 2014

Fingerprint

Funnel Chest
Opioid Analgesics
Postoperative Pain
Morphine
Pain
Length of Stay
Non-Steroidal Anti-Inflammatory Agents
Diazepam
Inpatients
Multivariate Analysis

Keywords

  • Morphine equivalent daily dose
  • Nuss procedure
  • Opioid
  • Pain
  • Pectus excavatum
  • Ravitch procedure

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

Cite this

Postoperative opioid analgesic use after Nuss versus Ravitch pectus excavatum repair. / Papic, Jonathan C.; Finnell, S. Maria; Howenstein, Abby M.; Breckler, Francine; Leys, Charles M.

In: Journal of Pediatric Surgery, Vol. 49, No. 6, 2014, p. 919-923.

Research output: Contribution to journalArticle

Papic, Jonathan C. ; Finnell, S. Maria ; Howenstein, Abby M. ; Breckler, Francine ; Leys, Charles M. / Postoperative opioid analgesic use after Nuss versus Ravitch pectus excavatum repair. In: Journal of Pediatric Surgery. 2014 ; Vol. 49, No. 6. pp. 919-923.
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abstract = "Background/Purpose Anticipated postoperative pain may affect procedure choice in patients with pectus excavatum. This study aims to compare postoperative pain in patients undergoing Nuss and Ravitch procedures. Methods A 5 year retrospective review was performed. Data on age, gender, Haller index, procedure, pain scores, pain medications, and length of hospital stay were collected. Total inpatient opioid administration was converted to morphine equivalent daily dose per kilogram (MEDD/kg) and compared between procedures. Results One hundred eighty-one patients underwent 125 (69{\%}) Nuss and 56 (31{\%}) Ravitch procedures. Ravitch patients were older (15.7 yo vs 14.6 yo, p = 0.004) and had a higher Haller index (5.21 vs 4.10, p = < 0.001). Nuss patients had higher average daily pain scores, received 25{\%} more opioids (MEDD/kg 0.66 vs. 0.49, p = < 0.001), and received twice as much IV diazepam/kg. In the multivariate analysis, higher MEDD/kg correlated with both the Nuss procedure and older age in the Nuss group. Opioid administration did not correlate with Haller index or Nuss bar fixation technique. Increased NSAID administration did not correlate with lower use of opioids. Conclusion The Nuss procedure is associated with greater postoperative pain compared to the Ravitch procedure. Opioid use is higher in older patients undergoing the Nuss procedure, but is not associated with severity of deformity.",
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