Bhatnagar Vishal, Kumar Ravi, Singh Anshu, Singh Manish, Darlong L M, Mittal Amit Kumar
Surgical Intensive Care Unit, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, IND.
Plastic Surgery, King George's Medical University, Lucknow, IND.
Cureus. 2023 Jul 3;15(7):e41301. doi: 10.7759/cureus.41301. eCollection 2023 Jul.
Pectus deformities are commonly seen in chest wall deformities among the pediatric age group. Pectus deformities occur due to defective growth of the sternum and its surrounding cartilage. The Nuss procedure is the technique of choice for correcting the deformity surgically which includes placing a convex bar under the sternum without resection or injury to costal cartilages. Adequate pain control is utmost to improve wound healing, patient satisfaction, short hospital stays, and decrease the financial burden on attendants. Therefore, it is necessary to investigate which analgesic method is more advantageous for the Nuss procedure.
To compare the analgesic effects of intravenous patient-controlled analgesia (IVPCA) morphine versus computerized ambulatory delivery device (CADD) epidural morphine on acute post-operative pain management in Nuss procedures.
A retrospective study was done at Rajiv Gandhi Cancer and Research Hospital, New Delhi from 2015 to 2020 to assess the efficacy and safety between IVPCA morphine and CADD epidural for post-operative analgesia following pectus excavatum repair. A total of 34 cases of Nuss procedures were taken with 17 cases in each group. Group 1 (intravenous PCA morphine) was given 39 ml normal saline + 6 ml morphine (total 45 ml, 2 mg/ml morphine), set at demand dose 0.5 ml, i.e. 1 mg, lockout interval 7 minutes, doses per hour was six and Group 2 (CADD epidural morphine) was given 42 ml normal saline + 3 ml morphine (1 mg/ml morphine) with continuous infusion at the rate of 0.5 ml/hr. Demand dose 0, lockout interval nil. Visual analog pain scores using a scale of 0-10 and Ramsay Sedation Score (RSS) scores were obtained on arrival at the post-anesthesia care unit, at 12, 24, 48, and 72 hours throughout the subsequent hospital stay.
This study yielded positive information about our experience with the pectus post-operative pain management. The mean visual analog scale (VAS) score was lower in Group 1 compared to Group 2 but significantly different at 12 and 72 hours only. The mean RSS score was comparable between groups. The mean hospital stay (days) and requirement of rescue analgesia doses were 3.47±0.51 and 0.12±0.33 in Group 1 and 4.76±0.44, 0.59±1.12 in Group 2.
Both IVPCA morphine and CADD morphine were effective in controlling post-surgical pain in the Nuss procedure, but IVPCA morphine was better as compared to CADD morphine in this regard because it was noninvasive, safe, and cost-effective with non-significant complications.
漏斗胸畸形是小儿年龄组中常见的胸壁畸形。漏斗胸畸形是由于胸骨及其周围软骨生长缺陷所致。努氏手术是外科矫正该畸形的首选技术，包括在胸骨下方放置一根凸杆，而不切除或损伤肋软骨。充分的疼痛控制对于促进伤口愈合、提高患者满意度、缩短住院时间以及减轻护理人员的经济负担至关重要。因此，有必要研究哪种镇痛方法对努氏手术更具优势。
比较静脉自控镇痛（IVPCA）吗啡与电脑自控镇痛泵（CADD）硬膜外吗啡在努氏手术急性术后疼痛管理中的镇痛效果。
2015年至2020年在新德里的拉吉夫·甘地癌症与研究医院进行了一项回顾性研究，以评估IVPCA吗啡和CADD硬膜外镇痛在漏斗胸修复术后镇痛的有效性和安全性。共纳入34例努氏手术病例，每组17例。第1组（静脉PCA吗啡组）给予39毫升生理盐水+6毫升吗啡（共45毫升，2毫克/毫升吗啡），设定按需剂量0.5毫升，即1毫克，锁定间隔7分钟，每小时剂量为6次；第2组（CADD硬膜外吗啡组）给予42毫升生理盐水+3毫升吗啡（1毫克/毫升吗啡），以0.5毫升/小时的速度持续输注。按需剂量0，锁定间隔无。在到达麻醉后护理单元时、随后住院期间的12、24、48和72小时，使用0至10分的视觉模拟疼痛评分量表和拉姆齐镇静评分（RSS）量表进行评分。
本研究得出了关于我们漏斗胸术后疼痛管理经验的积极信息。第1组的平均视觉模拟量表（VAS）评分低于第2组，但仅在12和72小时时有显著差异。两组的平均RSS评分相当。第1组的平均住院天数和急救镇痛剂量需求分别为3.47±0.51和0.12±0.33，第2组为4.76±0.44和0.59±1.12。
IVPCA吗啡和CADD吗啡在控制努氏手术术后疼痛方面均有效，但在这方面IVPCA吗啡比CADD吗啡更好，因为它无创、安全且具有成本效益，并发症不显著。
