Pectus ESC Outcomes and Comparative Effectiveness Study

Study Overview
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Brief Summary
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Investigators hypothesize that Erector spinae catheter pain management protocol would allow patients to have earlier and more effective rehabilitation with decreased length of hospital stay. The aims are to compare LOS between the two groups (epidural and ES groups). Secondary aims are to compare recovery outcomes (mobilization time), time required to do the blocks, pain scores and opioid use during hospitalization and on follow up after discharge until Pain clinic visit, side effects, family satisfaction and readmissions among the two groups. In addition, in-hospital and post-discharge outcomes in subjects who received ESP protocol will be studied.

Detailed Description
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Retrospective study - Electronic medical records of consecutive patients who underwent pectus surgery between January and December of 2019 (epidural protocol) and those who underwent same procedure between June 2020 to May 2021, will be evaluated. Covariates and outcomes described in sections below will be recorded from EMR. The data included records from flowsheets, pain team notes based on follow up questionnaires administered by phone after discharge until after ESP catheters were removed, as well as pain clinic notes.

Official Title
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Pragmatic Study Comparing Outcomes of Multimodal Epidural and Erector Spinae Catheter Pain Protocols After Pectus Surgery

Conditions
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Pectus Excavatum, Pain, Postoperative

Intervention / Treatment
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* Other: Multimodal Erector spinae catheter protocol


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age>8 years Diagnosis of pectus excavatum who underwent Nuss procedure Pain regimen included either epidural catheter or ES catheters Exclusion Criteria: Developmental delay prior pectus repair concomitant procedures

Ages Eligible for Study
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Minimum Age: 8 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Epidural<br>Patients who underwent Nuss procedure under epidural protocol (between January and December of 2019) | |
| ESP<br>Patients who underwent Nuss procedure using ESP catheter protocol (June 2020 to April 2021) | Other: Multimodal Erector spinae catheter protocol<br>* Patients either received multimodal epidural or ESP protocol<br>* Other names: Multimodal epidural protocol;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Length of stay | Date of surgery to hospital discharge | Upto 10 days after surgery | 
| Mobilization | Meeting PT goals | After surgery in-hospital, phone calls until POD6, pain clinic and surgery clinic postop visit (within 4 weeks after surgery) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain measures | Pain scores postoperative and opioid/benzodiazepine use | After surgery in-hospital, phone calls until POD6, pain clinic and surgery clinic postop visit (within 4 weeks after surgery) | 
| Side effects | ED visit, readmission, numbness, infection, LA toxicity etc. | After surgery in-hospital, phone calls until POD6, pain clinic and surgery clinic postop visit (within 4 weeks after surgery) |