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Initial surgical and pain management outcomes after Nuss procedure. J Pediatr Surg 2010 Sep;45(9):1767-71

Date

09/21/2010

Pubmed ID

20850618

DOI

10.1016/j.jpedsurg.2010.01.028

Scopus ID

2-s2.0-77956834479   32 Citations

Abstract

PURPOSE: The purpose of this article was to report surgical and pain management outcomes of the initial Nuss procedure experience at the Children's Hospital of Wisconsin (Milwaukee) and to place this experience in the context of the published literature.

METHODS: The initial 118 consecutive Nuss procedures in 117 patients were retrospectively reviewed with approval of the Children's Hospital of Wisconsin human rights review board. Patient, surgical, complication, and pain descriptors were collected for each case. Statistical methods for comparison of pain strategies included the Kolmogorov-Smirnov test for normality, 1-way repeated measures analysis of variance, and paired t tests.

RESULTS: Patient, surgical, and complication descriptors were comparable to other large series. Complication rates were 7% early and 25% late. Epidural success rate was 96.4%. There was 1 episode of recurrence 2 years postbar removal (n = 114).

CONCLUSIONS: The institution of the Nuss procedure provides a highly desired result with significant complication rates. The ideal approach would deliver this result with lower risk. A pain service-driven epidural administration of morphine or hydromorphone with local anesthetic provides excellent analgesia for patients after Nuss procedure. The success of epidural analgesia is independent of catheter site and adjunctive medications. Ketorolac was an effective breakthrough medication.

Author List

Densmore JC, Peterson DB, Stahovic LL, Czarnecki ML, Hainsworth KR, Davies HW, Cassidy LD, Weisman SJ, Oldham KT

Authors

Laura Cassidy PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
W. Hobart Davies Professor & Chair in the Phychology department at University of Wisconsin - Milwaukee
John C. Densmore MD Professor in the Surgery department at Medical College of Wisconsin
Keri Hainsworth PhD Associate Professor in the Anesthesiology department at Medical College of Wisconsin
Keith T. Oldham MD Professor in the Surgery department at Medical College of Wisconsin
Steven J. Weisman MD Professor in the Anesthesiology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Analgesia, Epidural
Child
Female
Funnel Chest
Humans
Male
Pain, Postoperative
Retrospective Studies
Thoracic Surgical Procedures
jenkins-FCD Prod-484 8aa07fc50b7f6d102f3dda2f4c7056ff84294d1d