Epidural vs patient-controlled analgesia for postoperative pain after pectus excavatum repair: a prospective, randomized trial

Peter, Shawn D. St.; Weesner, Kathryn A.; Weissend, Eric E.; Sharp, Susan W.; Valusek, Patricia A.; Sharp, Ronald J.; Snyder, Charles L.; Holcomb, George; Ostlie, Daniel J.

doi:10.1016/j.jpedsurg.2011.10.040

Cited by 86 publications

(66 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…PCA over TEA was not found to be an advantage as has been reported for children recovering after MIRPE (14). PCA on-demand dosing alone was unsuccessful at maintaining acceptable pain levels and a number of patients experienced complications related to respiratory depression and severe sedation when continuous background dosing was used.…”

Section: Mean Pain Scorementioning

confidence: 77%

“…Although we enrolled the same number of patients in each group at randomization, the On-Q arm was larger because 13 patients (15.3%) in TEA group voluntarily withdrew before treatment due to perceived risks of epidural catheter placement and perceived benefits of On-Q pain management system (14,18,20). Despite this imbalance, the groups were not significantly different in regard to characteristics compared.…”

Section: Mean Pain Scorementioning

confidence: 99%

“…Hospitalization may be prolonged in adult patients after MIRPE due to uncontrolled pain (8,11,12). Thoracic epidural analgesia (TEA) and intravenous patient-controlled analgesia (PCA) are effective in younger patients; however, reports of postoperative pain regimens in adults are limited (11,(13)(14)(15)(16)(17). Tunneled, anesthetic-infiltrating catheters are being used increasingly after thoracic procedures such as thoracotomy in lieu of TEA with some reports showing earlier hospital discharge for patients who receive this type of analgesia (18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Randomized trial of epidural vs. subcutaneous catheters for managing pain after modified Nuss in adults

et al. 2016

View full text Add to dashboard Cite

Background: Minimally invasive repair of pectus excavatum (MIRPE) is now performed in adults.Managing adult patients' pain postoperatively has been challenging due to increased chest wall rigidity and the pressure required for supporting the elevated sternum. The optimal pain management regimen has not been determined. We designed this prospective, randomized trial to compare postoperative pain management and outcomes between thoracic epidural analgesia (TEA) and bilateral subcutaneous infusion pump catheters (On-Q). Methods: Patients undergoing MIRPE (modified Nuss) underwent random assignment to TEA or On-Q group. Both groups received intravenous, patient-controlled opioid analgesia, with concomitant delivery of local anesthetic. Primary outcomes were length of stay (LOS), opioid use, and pain scores. Results: Of 85 randomly assigned patients, 68 completed the study [52 men, 76.5%; mean (range) age, 32.2 (20.0-58.0) years; Haller index, 5.9 (range, 3.0-26.7)]. The groups were equally matched for preoperative variables; however, the On-Q arm had more patients (60.3%). No significant differences were found between groups in mean daily pain scores (P=0.52), morphine-equivalent opioid usage (P=0.28), or hospital stay 3.5 vs. 3.3 days (TEA vs. On-Q; P=0.55). Thirteen patients randomized to TEA refused the epidural and withdrew from the study because they perceived greater benefit of the On-Q system.Conclusions: Postoperative pain management in adults after MIRPE can be difficult. Both continuous local anesthetic delivery by TEA and On-Q catheters with concomitant, intravenous, patient-controlled anesthesia maintained acceptable analgesia with a reasonable LOS. In our cohort, there was preference for the On-Q system for pain management.

show abstract

Section: Mean Pain Scorementioning

confidence: 77%

Section: Mean Pain Scorementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Randomized trial of epidural vs. subcutaneous catheters for managing pain after modified Nuss in adults

et al. 2016

View full text Add to dashboard Cite

show abstract

“…All patients were given the opportunity to participate in the study. Postoperatively, all patients received either patient controlled analgesia (PCA) or analgesia via epidural catheter 18. Participants were excluded if they had inadequate baseline cognitive functioning or understanding of the English language to adequately understand the pain self-report questionnaires, or if they had any known allergies to the pain medications used in the postoperative pain management protocol.…”

Section: Methodsmentioning

confidence: 99%

Pupillometry: a non-invasive technique for pain assessment in paediatric patients

Connelly

Brown

Kearns

et al. 2014

Archives of Disease in Childhood

View full text Add to dashboard Cite

Objective Pupillometry has been used to assess both pain intensity and response to analgesic medications in adults. The aim of this observational study was to explore proof-of-concept for the use of this technique in paediatric patients. Changes in pupil parameters before and after opioid exposure also were evaluated. Design and Setting This was a single-center, prospective study conducted at an academic paediatric medical center. Patients Children 9-17 years of age undergoing elective surgical correction of pectusexcavatum were enrolled into a protocol approved by the human ethical committee (IRB). Interventions Pupil size and reactivity were measured using a hand-held pupillometer. Pain was assessed using age-appropriate, validated pain self-report scales. Results Thirty patients were enrolled. Each point change on a 10 cm visual analog pain intensity scale was associated with a statistically significant mean change of 0.11 mm/s in maximum pupil constriction velocity, and of approximately 0.4% in pupil diameter. As expected, there was an association between total opioid dose (expressed as morphine equivalents) and pupil diameter. Age, sex, and baseline anxiety scores did not correlate significantly with pupillary response. Conclusion The association of both maximum pupillary constriction velocity and diameter with pain scores illustrates the potential for using pupillometry as a non-invasive method to objectively quantitate pain response/intensity in children. The technique holds promise as a pharmacodynamic “tool” to assess opioid response in paediatric patients.

show abstract

“…93 No GRP, a taxa de complicação foi menor que no GC, e neste grupo, a ocorrência foi superior ao demonstrado na literatura. No entanto, não houve diferença entre os grupos quanto a intensidade da dor na avaliação pós-operatória, diante disto, consideramos que esta complicação não influenciou o resultado dos testes, e ainda podemos sugerir que a reabilitação precoce não aumentou o risco para deslocamento do cateter peridural torácico.…”

Section: Discussionunclassified

Capacidade funcional de exercício e função pulmonar em pacientes submetidos a um programa de reabilitação precoce após técnica de Nuss: um estudo controlado randomizado

S¹

View full text Add to dashboard Cite

Capacidade funcional de exercício e função pulmonar em pacientes submetidos a um programa de reabilitação precoce após técnica de Nuss: um estudo controlado randomizado São Paulo 2016 DedicatóriaAos meus pais, Moisés e Altair, por acreditarem em mim mais do que eu mesma e pelos sacrifícios realizados em razão dos meus sonhos e dos sonhos dos meus irmãos.Aos meus irmãos Marcus, Moisés e Diego, por trazerem tantas alegrias a minha vida e por fazerem de mim uma pessoa melhor.Ao meu esposo Thiago, por ser um dos motivos para concretização deste estudo, por tudo que representa na minha vida e por ser meu exemplo de força e determinação. Esta conquista é nossa!! Amo vocês!! AgradecimentosA Deus, por tantas graças alcançadas.Aos meus pais, por me ensinarem o valor do amor em família, do respeito para com todos, a importância da eterna aprendizagem e que temos sempre que lutar pelos nossos objetivos. Muito obrigada!! Aos meus irmãos, pelo cuidado, proteção, companheirismo, amor, por tantos momentos divididos e por sempre me apoiarem em todas as fases da minha vida.Ao meu esposo Thiago, pelo amor, carinho, incentivo e paciência, pelas sugestões e críticas, por não me deixar desanimar e por estar sempre ao meu lado.Aos meus sogros, Tarcísio e Rosana, pela calorosa acolhida na sua família, pelo carinho, apoio e torcida.As amigas Mariana e Majana, que aceitaram junto comigo vir a São Paulo.A amiga Priscila Ramos, por tantas batalhas enfrentadas para conseguirmos a pós-graduação, pela ajuda e companheirismo.Ao Prof. Dr. João Carlos das Neves Pereira, por abrir as portas para o início desta jornada, pelos ensinamentos científicos e humanos, e por me mostrar o caminho a seguir.À Dra. Rosângela Monteiro, pela disponibilidade, ajuda, sugestões e orientações tão importantes para a realização deste estudo.Ao Prof. Dr. José Ribas Milanez de Campos, pela acolhida num momento de muitas mudanças e por permitir a realização deste estudo. Obrigada pela oportunidade.Aos pacientes que aceitaram participar deste estudo, por se colocarem a disposição da ciência.A equipe de enfermagem do centro cirúrgico e da unidade de internação do 8º andar e ao escriturário Rafael, pela ajuda indispensável na coleta de dados.A Juliana Lattari Sobrinho, Neusa Rodrigues, Tatiane Lago, Mônica Souto da Secretaria da Pós-Graduação, pela colaboração constante em todos os aspectos burocráticos.Aos amigos construídos, Laura, Natália, Thales, Aída, Aristides e Karina Andrighetti, pela ajuda, sugestões e por tornar a pós-graduação mais agradável.

show abstract

Epidural vs patient-controlled analgesia for postoperative pain after pectus excavatum repair: a prospective, randomized trial

Cited by 86 publications

References 16 publications

Randomized trial of epidural vs. subcutaneous catheters for managing pain after modified Nuss in adults

Randomized trial of epidural vs. subcutaneous catheters for managing pain after modified Nuss in adults

Pupillometry: a non-invasive technique for pain assessment in paediatric patients

Capacidade funcional de exercício e função pulmonar em pacientes submetidos a um programa de reabilitação precoce após técnica de Nuss: um estudo controlado randomizado

Contact Info

Product

Resources

About