P0983 - Reducing the Pain: Evaluation of Different Pain Management Algorithms after Pectus Excavatum Repair

Background
Thoracoscopic-assisted repair (Nuss procedure) allows immediate complete correction of severe pectus excavatum deformities. However, postoperative pain can be prohibitive, resulting in hesitation for patients in seeking surgery. The purpose of this study was to understand the pain control with different regimens in our experience.

Methods
All patients who underwent minimally invasive repair of pectus excavatum between 1/1/2011 and 1/31/2020 were included. Data regarding preoperative history and management, intraoperative course, and post-operative outcomes were collected. Patients were analyzed based upon primary type of analgesia used (thoracic epidural, sub-pleural elastomeric pump, and thoracic intercostal nerve cryoablation). All cases received multi-modal pain control. Hospital length of stay and total narcotic use measured as oral morphine equivalents were used as a proxy for pain control. Univariate analysis was conducted.

Results
Sixty (60) cases had surgical repair during the study period. Mean age was 18.1 years, with 76.7% male and 86.7% Caucasian. Average Haller index was 4.7, and the mean duration of symptoms was 14.1 years. Analgesia was achieved in 29 cases with a thoracic epidural, 20 cryoablation and 11 had elastomeric pumps placed. There were no differences in age, gender, Haller index, insurance status, or number of bars used for repair between the three groups. The duration of operation was significantly shorter for epidural. Cryoablation resulted in a lower length of ICU and hospital LOS (table). When comparing the total inpatient narcotic use, we noted 454.3 mg, 725.4 mg, and 238.9 mg morphine equivalents for epidural, pump, and cryoablation cases respectively (p<0.002).

Conclusions
Cryoablation was the most effective technique for early post-operative pain control in our series as measured by length of stay and morphine equivalent narcotic use while in the hospital. Further multicenter trials would be beneficial to understand the role of these analgesic techniques.