Nuss Procedure: Clinical Options in Pediatric Pain Management?

Study Overview
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Brief Summary
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A retrospective chart review study analyzing the benefits of patient controlled analgesia, thoracic epidural analgesia, and paravertebral nerve block catheters in patients having surgical repair of pectus excavatum using the Nuss procedure.

Conditions
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Pectus Excavatum

Intervention / Treatment
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* Device: Patient controlled analgesia
* Procedure: Continuous thoracic epidural infusions
* Procedure: Continuous paravertebral blockade


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients undergoing the NUSS procedure since the beginning of 2011 to Sept. 30th, 2013. Exclusion Criteria: None
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 |
| --- | --- |
| Patient controlled analgesia<br>Use of patient controlled analgesia (PCA) for the management of postoperative pain after the Nuss procedure. | Device: Patient controlled analgesia<br>* A programable electronically controlled infusion pump that delivers an amount of intravenous analgesic when the patient presses a button.<br>|
| Continuous thoracic epidural infusion<br>Continuous thoracic epidural infusions (TE) for the management of postoperative pain after the Nuss procedure. | Procedure: Continuous thoracic epidural infusions<br>* Continuous thoracic epidural infusions (TE) involves continuous infusion of drugs through a catheter placed into the epidural space, resulting in a loss of sensation-including the sensation of pain-by blocking the transmission of signals through nerve fibers in or near the spinal cord.<br>|
| Continuous paravertebral blockade<br>Continuous paravertebral blockade (PVB) for the management of postoperative pain after the Nuss procedure. | Procedure: Continuous paravertebral blockade<br>* Continuous paravertebral blockade (PVB) is the technique of injecting local anesthetic adjacent to the thoracic vertebra that anesthetizes the spinal nerve roots after they exit the spinal canal.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total morphine dose | Total morphine dose will be evaluated in mg/kg/24 hour period, beginning with post-op day 0 until discharge from the hospital. | Participants will be followed for the duration of hospital stay, an expected average of 3 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain score | Pain scores obtained from the visual analog scale. | Participants will be followed for the duration of hospital stay, an expected average of 3 days | 
| Length of hospitalization | Determine if there is a difference in length of hospitalization, and time to discharge. | Within the first week after surgery. | 
| Nausea and vomiting | Determine the incidence of nausea and vomiting measured by the postoperative ondansetron dosing, beginning with arrival to floor and up to the first 48 hrs of hospitalization. | 0-48 hrs. post-op |