Skip to main content

Pain Management in the Surgical Correction of Chest Wall Deformities

  • Chapter
  • First Online:
Chest Wall Deformities and Corrective Procedures

Abstract

The thoracoscopic placement of Nuss pectus bars for the correction of pectus excavatum is a painful procedure., which poses a challenge for the thoracic anaesthetist. Adequate pain management can expedite post-operative recovery and reduce complications. It may also prevent the development of chronic post-operative pain. Previously thoracic epidural analgesia has been favoured by centres in North America and Europe, but there is tendency to move away from this in favour of a multimodal approach to analagesia, including regional blockade, opiate infusions and patient-controlled analagesia, with non-steroidal anti-inflammatory drugs, paracetamol and other novel analgesics given in addition for their synergistic and opiate sparing effects

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 49.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 64.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Castellani C, Schalamon J, Saxena AK, Hoellwarth ME. Early complications of the Nuss procedure for pectus excavatum a prospective study. Pediatr Surg Int. 2008;24(6):659–66.

    Article  PubMed  Google Scholar 

  2. Muhly WT, Maxwell LG, Cravero JP. Pain management following the Nuss procedure: a survey of practice and review. Acta Anaesthesiol Scand. 2014;58(9):1134–9.

    Article  CAS  PubMed  Google Scholar 

  3. Stroud AM, Tulanont DD, Goates TE, Goodnev PP, Croitoru D. Epidural analgesia versus intravenous patient-controlled analgesia following minimally invasive pectus excavatum repair: a systemic review and meta-analysis. J Pediatr Surg. 2014;9(5):798–806.

    Article  Google Scholar 

  4. Grosen K, Pteiffer-Jensen M, Pilegaard HK. Postoperative consumption of opioid analgesics following correction of pectus excavatum is influenced by pectus severity: a single-centre study of 236 patients undergoing minimally invasive correction of pectus excavatum. Eur J Cardiothorac Surg. 2010;37(4):833–9.

    Article  PubMed  Google Scholar 

  5. Van Aken H, Thys L, Veekman L, Buerkle H. Assessing analgesia in a single and repeated administrations or propacetamol for postoperative pain: comparison with morphine after dental surgery. Anesth Analg. 2004;98:159–65.

    Article  PubMed  Google Scholar 

  6. Clarke H, Bonin RP, Orser BA, Englesaki M, Wijeysundera DN, Katz J. The prevention of chronic postsurgical pain using gabapentin and pre-gabalin: a combined systemic review and meta-analysis. Anesth Analg. 2012;115(2):428–42.

    Article  CAS  PubMed  Google Scholar 

  7. Hall Burton DM, Boretsky KR. A comparison of paravertebral nerve block catheters and thoracic epidural catheters for post-operative analgesia following the Nuss procedure for pectus excavatum repair. Paediatr Anaesth. 2014;24(5):516–20.

    Article  PubMed  Google Scholar 

  8. Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy – a systematic review and meta-analysis of randomized trials. Br J Anaesth. 2006;96:418–42.

    Article  CAS  PubMed  Google Scholar 

  9. Joshi GP, Bonnet F, Shah R, Wilkinson RC, Camu F, Fischer B, Neugebauer EA, Rawal N, Schug SA, Simanski C, Kehlet H. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg. 2008;107:1026–40.

    Article  CAS  PubMed  Google Scholar 

  10. Lukošienė L, Kalibatienė L, Barauskas V. Intercostal nerve block in pediatric minimally invasive thoracic surgery. Acta Medica Lituanica. 2012;19(3):150.

    Google Scholar 

  11. Lukosiene L, Macas A, Trepenaltis D, Malcius D, Barauskas V. Single shot intercostal block for pain management in pediatric patients undergoing the Nuss procedure: a double blind randomised controlled study. J Pediatr Surg. 2014;49(12):1735–7.

    Article  Google Scholar 

  12. Horlocker TT. Regional anaesthesia in a patient receiving antithrombotic and anti-patelet therapy. Br J of Anaesth. 2011;107(S1):96–106.

    Article  Google Scholar 

  13. NAP3 Report and findings of the third National Audit Project of the Royal College of Anaesthetists. Pages1–36. Published by the Royal College of Anaesthetists; 2009.

    Google Scholar 

  14. Wildsmith JA. Continuous thoracic epidural block for surgery: gold standard or debased currency? Br J Anaesth. 2012;109(1):9–12.

    Article  CAS  PubMed  Google Scholar 

  15. Powell ES, Pearce AC, Cook D, Davies P, Bishay E, Bowler GM, Gao F, UKPOS Co-ordinators. UK pneumonectomy outcome study (UKPOS): a prospective observational study of pneumonectomy outcome. J Cardiothorac Surg. 2009;30:4–41.

    Google Scholar 

  16. St Peter SD, Weesner KA, Weissend EE, Sharp SW, Valusek PA, Sharp RJ, Snyder CL, Hotcomb 3rd GW, Ostlie DJ. Epidural vs patient-controlled analgesia for postoperative pain after pectus excavatum repair: a prospective randomized trial. J Pediatr Surg. 2012;47(1):148–53.

    Article  PubMed  Google Scholar 

  17. St Peter SD, Weesner KA, Sharp RJ, Sharp SW, Ostlie DJ, Hotcomb 3rd GW. Is epidural analgesia truly the best pain management strategy after minimally invasive pectus excavatum repair? J Pediatr Surg. 2008;43(1):79–82.

    Article  PubMed  Google Scholar 

  18. Meylan N, Elia N, Lysakowski C, Tramer MR. Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing major surgery: meta-analysis of randomized trials. Br J Anaesth. 2009;102(2):156–67.

    Article  CAS  PubMed  Google Scholar 

  19. Lobe TE. Perioperative hypnosis reduces hospitalisation in patients undergoing the Nuss procedure excavatum. J Laparoendosc Adv Surg Tech A. 2006;16(6):639–42.

    Article  PubMed  Google Scholar 

  20. Perttunen K, Tasmuth T, Kalso E. Chronic pain after thoracic surgery: a follow up study. Acta Anaesthesiol Scand. 1999;43(5):563–7.

    Article  CAS  PubMed  Google Scholar 

  21. Katz J, Jackson M, Kavanagh BP, Sandler AN. Acute pain after thoracic surgery predicts long-term post-thoracotomy pain. Clin J Pain. 1996;12(1):50–5.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Elizabeth M. C. Ashley BSc, MBChB, FRCA, FFICM .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Ashley, E.M.C. (2016). Pain Management in the Surgical Correction of Chest Wall Deformities. In: Kolvekar, S., Pilegaard, H. (eds) Chest Wall Deformities and Corrective Procedures. Springer, Cham. https://doi.org/10.1007/978-3-319-23968-2_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-23968-2_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23966-8

  • Online ISBN: 978-3-319-23968-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics