Surgical repair of
pectus excavatum can be associated with significant
postoperative pain. Various
analgesic modalities have been suggested including thoracic
epidural analgesia and intravenous
patient-controlled analgesia (IV PCA). The current study compares the efficacy and adverse efficacy profile of these 2
analgesic modalities. The charts of 18 adolescents who had undergone
pectus excavatum repair were retrospectively reviewed and divided into 2 groups: thoracic
epidural analgesia (E) or IV PCA (I). Demographic data included age, weight, sex, and
anesthesia/
surgical times. Treatment days (defined as the number of days the patients received intravenous or
epidural analgesia), time to oral intake, and time to discharge from the hospital were also recorded.
Pain scores using a visual analogue scale ranging from 0 (no
pain) to 10 (worst imaginable
pain) and sedation scores were recorded in the postanesthesia care unit and at 6, 12, 24, 36, 48, and 60 hours postoperatively. The charts were also reviewed for side effects including
nausea and/or
vomiting,
pruritus,
oxygen desaturation, and
respiratory depression. The study cohort included 18 patients divided equally into group E (
epidural analgesia) (n = 9) and group I (IV PCA). There were no statistically significant differences between the 2 groups with regard to demographic data, time to oral intake, and time to hospital discharge.
Anesthesia to surgery times were longer in group E compared with group I (43 +/- 11 versus 25 +/- 11 minutes, P = 0.004), but there was no difference in overall surgery and
anesthesia times. The number of treatment days (days that the patients received intravenous or epidural medications) was decreased in group E versus group I (2.3 +/- 0.7 versus 3.3 +/- 1.0 days, P = 0.027). There was no difference between the 2 groups in regard to the onset of oral intake or hospital discharge time.
Pain scores were initially higher in the postanesthesia care unit in group E versus group I (6.78 +/- 2.17 versus 5.78 +/- 3.77); however, after that point,
pain scores were lower in group E than in group I. There was no difference between the 2 groups in regard to sedation scores or adverse effect profile.
Epidural analgesia provided better
pain control than the intravenous route for the management of patients after
pectus excavatum repair. No adverse effects related to
epidural analgesia were noted. The only issue identified with thoracic
epidural anesthesia was a mean increase of 18 minutes for
anesthesia time required for
catheter placement before the start of the case.