Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, 9500 Euclid Avenue / A12-329, Cleveland, OH 44195, USA.
Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, 9500 Euclid Avenue / A12-329, Cleveland, OH 44195, USA.
J Pediatr Surg. 2022 Feb;57(2):213-218. doi: 10.1016/j.jpedsurg.2021.10.034. Epub 2021 Oct 30.
The Nuss procedure for pectus excavatum has historically been associated with significant postoperative pain, which has been the major factor contributing to hospital length of stay (LOS).
A single-institution, prospective study of 40 consecutive patients undergoing Nuss bar placement for pectus excavatum between November 2019 and January 2021 was conducted to assess the effectiveness of a multimodality pain management protocol. All patients received T3-T8 intercostal nerve cryoablation (INC), T3-T8 bupivacaine intercostal nerve blocks, Exparel at the skin incisions, and management with a perioperative analgesia regimen that minimized narcotic usage. The primary outcome was LOS. Secondary outcomes included opioid use, pain scores, and time to sensory recovery.
37/40 patients (92.5%) were discharged home on postoperative day (POD) 1, and 3/40 (7.5%) were discharged on POD 2 (mean LOS = 1.1 days). The median average postoperative pain score was 2/10. After eliminating IVPCA from our protocol, total oral morphine equivalent (OME) decreased by 73% (55.5 mg to 15 mg) with no change in pain scores or discharge timing.
INC combined with bupivacaine intercostal nerve blocks and a pre- and post-hospital analgesia protocol facilitated discharge one day after the Nuss procedure, achieved excellent pain control, and eliminated the need for intravenous opioids.
漏斗胸的 Nuss 手术历来与明显的术后疼痛相关，这是导致住院时间（LOS）延长的主要因素。
对 2019 年 11 月至 2021 年 1 月期间接受 Nuss 棒置入术治疗漏斗胸的 40 例连续患者进行了单中心前瞻性研究，以评估多模式疼痛管理方案的有效性。所有患者均接受 T3-T8 肋间神经冷冻消融术（INC）、T3-T8 布比卡因肋间神经阻滞、切口处的 Exparel 以及围手术期镇痛方案的管理，以最大限度减少阿片类药物的使用。主要结局是 LOS。次要结局包括阿片类药物使用、疼痛评分和感觉恢复时间。
40 例患者中有 37 例（92.5%）在术后第 1 天出院，有 3 例（7.5%）在术后第 2 天出院（平均 LOS=1.1 天）。术后平均疼痛评分为 2/10。在从我们的方案中去除 IVPCA 后，总口服吗啡等效物（OME）减少了 73%（从 55.5mg 减少至 15mg），而疼痛评分或出院时间没有变化。
INC 联合布比卡因肋间神经阻滞和术前及术后镇痛方案可促进 Nuss 手术后一天出院，实现了极好的疼痛控制，并消除了对静脉内阿片类药物的需求。
