Retrospective study comparing outcomes of multimodal epidural and erector spinae catheter pain protocols after pectus surgery

Walter, Charlotte M.; Lee, Christopher S; Moore, David L.; Abbasian, Niekoo; Clay, Smokey; Mecoli, Marc; Olbrecht, Vanessa A.; Batra, Manav; Ding, Lili; Fang, Yang; Nair, Manu; Huq, Abraar; Simpson, Blair; Brown, Rebeccah L.; Garcia, Victor F.; Chidambaran, Vidya

doi:10.1016/j.jpedsurg.2022.06.017

Cited by 5 publications

(25 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Five studies reported the LOS [19,[26][27][28][29]. Pain score (mostly measured using NRS in those studies describing it), opioid usage, and events of PONV were at least reported by one study each.…”

Section: Discussionmentioning

confidence: 99%

“…Continuous PVB was provided in four studies [17,18,28,29]. The patients in three studies received analgesia via ESPB catheter [19,26,27].…”

Section: Methodsmentioning

confidence: 99%

“…However, one article was excluded because the patients in both groups had single injections, not continued infusion. The remaining seven studies [17][18][19][26][27][28][29] were considered eligible for pooling by quantitative synthesis.…”

Section: Study Selectionmentioning

confidence: 99%

“…Two studies [18,27] reported the needle used in the nerve block group: 18G Pajunk needle and 20G B. Braun catheter. The location of TEA catheter placement was not mentioned in one study [28] and mainly reported at T4-T7 in other studies.…”

Section: Interventionsmentioning

confidence: 99%

“…Five studies reported opioid usage on post-operative day 1 to day 3 [17,18,26,27,29]. The meta-analysis showed no signi cant difference on post-operative day 1 (MD 0.29, 95% CI, -0.05 to 0.63; P = 0.10) and 2 (MD 0.19, 95% CI, -0.02 to 0.39; P = 0.08) but signi cantly high opioid usage in TEA group on post-operative day 3 (Fig.…”

Section: Opioid Usagementioning

confidence: 99%

See 4 more Smart Citations

Continuous nerve block versus thoracic epidural analgesia for post-operative pain of pectus excavatum repair: A systematic review and meta-analysis

Chen

Hsieh

et al. 2023

Preprint

View full text Add to dashboard Cite

Surgery to repair pectus excavatum (PE) is often associated with severe postoperative pain, which can impact the length of hospital stay (LOS). While thoracic epidural analgesia (TEA) has traditionally been used for pain management in PE, its placement can sometimes result in severe neurological complications. Recently, paravertebral block (PVB) and erector spinae plane block (ESPB) have been recommended for many other chest and abdominal surgeries. However, due to the more severe and prolonged pain associated with PE repair, it is still unclear whether continuous administration of these blocks is as effective as TEA. Therefore, we conducted this systematic review and meta-analysis to demonstrate the equivalence of continuous PVB and ESPB to TEA.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Continuous PVB was provided in four studies [17,18,28,29]. The patients in three studies received analgesia via ESPB catheter [19,26,27].…”

Section: Methodsmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Section: Interventionsmentioning

confidence: 99%

Section: Opioid Usagementioning

confidence: 99%

See 3 more Smart Citations

Continuous nerve block versus thoracic epidural analgesia for post-operative pain of pectus excavatum repair: A systematic review and meta-analysis

Chen

Hsieh

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

Combined erector spinae plane block with surgical intercostal nerve cryoablation for Nuss procedure is associated with decreased opioid use and length of stay

Aranda-Valderrama

Greenberg

Vecchione

et al. 2023

Reg Anesth Pain Med

View full text Add to dashboard Cite

Background and objectivesPain management for patients undergoing the Nuss procedure for treatment of pectus excavatum can be challenging. In an effort to improve pain management, our institution added bilateral single injection erector spinae plane (ESP) blocks to surgeon placed intercostal nerve cryoablation. We aimed to assess the efficacy of this practice change.MethodsRetrospective clinical data from a single academic medical center were evaluated. Due to an institutional change in clinical management, we were able to perform a before and after study. Twenty patients undergoing Nuss procedure who received bilateral ultrasound-guided single-shot T6 level ESP blocks and intercostal nerve cryoablation were compared with a historical control cohort of 20 patients who underwent Nuss procedure with intercostal nerve cryoablation alone. The primary outcome variables included postoperative pain scores, total hospital opioid use, and hospital length of stay.ResultsMedian total hospital intravenous morphine milligram equivalents was lower for the ESP group than for the control group (0.60 (IQR 0.35–0.88) vs 1.15 mg/kg (IQR 0.74–1.68), p<0.01). There was no difference in postoperative pain scores between the two groups. Mean hospital length of stay was 2.45 (SD 0.69) days for the control group and 1.95 (SD 0.69) days for the ESP group (p=0.03). No adverse events related to block placement were identified.ConclusionsIn a single-center academic practice, the addition of bilateral single injection ESP blocks at T6 to surgeon performed cryoablation reduced opioid consumption without a change in subjectively reported pain scores. The results from this pilot study can provide effect size estimates to guide the design of future randomized trials.

show abstract

Remote Patient Monitoring for Postoperative Pediatric Patients with Peripheral Nerve Catheters

McKee,

Williams,

Denker

2024

Journal of Pediatric Surgical Nursing

View full text Add to dashboard Cite

Background: Close follow up of postoperative orthopedic and pectus excavatum surgical patients discharged with a nerve catheter is required to ensure adequate pain management and recognize medication toxicity. Assessing ambulatory pediatric patients using a smartphone application is convenient and effective. Methods: A novel Remote Patient Monitoring (RPM) program was developed to improve follow-up and ability to assess postoperative pain management, analgesic toxicity, and catheter site. Adherence and successful graduation were measured to determine the success of the program. Additionally, patient and caregiver experience and opioid use were measured. Interventions: Patients were enrolled in RPM postoperatively for four days. The RPM nursing team reviewed patient reported data in real-time to address concerns and develop a plan of care. Pain management education was provided via video prior to removing the nerve catheter. Results: Adherence to RPM is over 90% for both populations, with 82% success rate in orthopedic patients and 93% success rate in pectus excavatum patients. Experience scores have been high, and opioid prescriptions have been reduced by half for the orthopedic population. Conclusions: RPM is an effective tool used to manage pediatric postoperative orthopedic and pectus excavatum surgical patients with significant patient and caregiver buy-in.

show abstract

Retrospective study comparing outcomes of multimodal epidural and erector spinae catheter pain protocols after pectus surgery

Cited by 5 publications

References 38 publications

Continuous nerve block versus thoracic epidural analgesia for post-operative pain of pectus excavatum repair: A systematic review and meta-analysis

Continuous nerve block versus thoracic epidural analgesia for post-operative pain of pectus excavatum repair: A systematic review and meta-analysis

Combined erector spinae plane block with surgical intercostal nerve cryoablation for Nuss procedure is associated with decreased opioid use and length of stay

Remote Patient Monitoring for Postoperative Pediatric Patients with Peripheral Nerve Catheters

Contact Info

Product

Resources

About