Document Type
Presentation
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Publication Date
6-28-2024
Abstract
Pectus excavatum is a chest wall deformity that can lead to cardiopulmonary complications in children, a vulnerable population due to risks for poor health outcomes and reduced healthcare access. Pectus excavatum is often corrected with a Nuss procedure, a surgery known to be painful. The field of pain management considers children to be a vulnerable population within their specialty due to risk of poorly managed pain, which may involve unnecessary or excessive opioid exposure. At present, anesthesiologists do not have a standardized method for postoperative pain management following Nuss; a variety of modalities are utilized, but large-scale clinical trials comparing options have not been completed. This study aims to compare a newer pain management modality, chest wall catheter, with other modalities, particularly nerve cryoablation, via a retrospective chart review of 83 patient records from 2013 to 2023 at Nemours Children’s Hospital, Delaware. This investigation found that in this cohort, chest wall catheter for pain management in Nuss procedure resulted in a mean hospital length of stay of 56.9 hours (SD = 14.3), mean in-hospital postoperative opioid requirements of 95.8 morphine milligram equivalents (SD = 83.8), and morphine milligram equivalents per kilogram of 1.8 MME/kg (SD = 1.7). These findings suggest that chest wall catheter is a non-inferior pain management modality compared to nerve cryoablation for these metrics, which may inform clinical decision making for anesthesiologists and pediatric surgeons.
Lay Summary
Children are vulnerable to worse health outcomes than the general population, especially when it comes to pain management. A health condition that affects children, which may decrease their ability to participate in exercise and everyday tasks due to decreased heart and lung function, is pectus excavatum. Pectus excavatum is a deformity of the chest in which the sternum compresses the heart and lungs. The condition may be corrected through a surgery called Nuss Procedure, but this surgery is known to be painful. There are several different options for pain management following the Nuss procedure, but there is presently no standardized method used throughout the field of anesthesiology. This study aimed to assess patient outcomes following the Nuss procedure when a chest wall catheter is used for pain management. A chest wall catheter is a device where a tube is placed into the chest wall and pain medication is delivered through the tube. Patient outcomes for chest wall catheter were compared to those for nerve cryoablation, a technique in which a device is used to freeze select nerves in the chest wall so that the nerves do not communicate pain signals. Patient medical records from Nemours Children’s Hospital, Delaware between 2013 and 2023 were assessed. The patient outcomes in this study were hospital length of stay and in-hospital opioid requirements. The results of this study were that chest wall catheter patients had an average hospital length of stay of 56.9 hours. For opioid use, results are reported in morphine milligram equivalents, which reflect conversion rates of all types of opioids in terms of morphine. The patients had an average of 95.8 morphine milligram equivalents, or 1.8 morphine milligram equivalents per kilogram of patient body weight. The results of this study show that chest wall catheter may not be an inferior pain management technique for the Nuss procedure compared to nerve cryoablation. Assessing the pain management technique that results in the lowest exposure to opioids is an important study in reducing the risk of children misusing opioids and other drugs. This is especially important in the context of the ongoing opioid epidemic. Larger-scale studies need to be done to investigate this technique, but these results may influence the clinical decisions of anesthesiologists and pediatric surgeons.
Recommended Citation
Barrett, Megan, "Chest Wall Catheters in Nuss Procedure: Postoperative Pain Management in a Vulnerable Population" (2024). Master of Public Health Capstone Presentations. Presentation 573.
https://jdc.jefferson.edu/mphcapstone_presentation/573
Language
English
Comments
Presentation: 5:35