脊柱侧弯矫形术患者术后慢性疼痛的危险因素

目的 探讨脊柱侧弯矫形术患者术后慢性疼痛(CPSP)的危险因素,并建立预测模型。方法 回顾性分析2017年1月至2020年9月择期行后入路脊柱侧弯矫形术206例患者资料,男88例,女118例,ASAⅠ—Ⅲ级,根据术后3个月是否发生CPSP将患者分为两组：CPSP组(n=76)和无CPSP组(n=130)。收集术前、术中和术后资料,并通过电话随访获取患者CPSP以及术后3个月并发症(如内固定松动、连接棒断裂、螺钉拔出等)的发生情况。采用多因素Logistic回归分析CPSP的危险因素并建立预测模型。结果 有76例(36.9%)患者发生CPSP。多因素Logistic回归分析显示：术前VAS疼痛评分>3分(OR=5.794,95%CI 2.224～15.097,P<0.001)、融合椎体数增加(每增加1个单位,OR=1.525,95%CI 1.256～1.853,P<0.001)、术后72 h VAS疼痛评分>3分(OR=3.022,95%CI 1.360～6.715,P=0.007)以及术后3个月内有并发症(OR=5.424,95%CI 1.058～27.800,...     

月经周期不同阶段对妇科腹腔镜手术后恶心呕吐的影响

目的观察月经周期不同阶段对妇科腹腔镜手术后恶心呕吐(PONV)的影响。方法选择2016年3月至2017年2月在北京大学第一医院接受全身麻醉下妇科腹腔镜手术的患者228例。根据患者在手术日处于月经周期的不同阶段分为卵泡期(n=98)、排卵期(n=79)和黄体期(n=51)。收集围术期资料,记录术后0~2h、0~24h内恶心呕吐的发生情况。采用Logistic回归模型分析月经周期不同阶段对PONV发生率的影响。结果术后0~2h有53例(23.2%)患者发生PONV,0~24h有125例(54.8%)PONV。单因素分析显示:月经周期不同阶段PONV发生率差异无统计学意义。多因素Logistic回归分析显示:手术时间1h(OR=3.176,95%CI 1.567~6.436,P=0.001)、PONV史(OR=5.711,95%CI 1.710~19.080,P=0.005)是术后0~2h恶心呕吐的独立危险因素;手术时间1h(OR=2.577,95%CI 1.460~4.549,P=0.001)、术后使用PCA泵(OR=2.671,95%CI 1.224~5.831,P=0.014)、术后应用甲硝唑(OR=2.728,95%CI 1.413~5.267,P=0.003)是术后0~24h恶心呕吐的独立危险因素。结论月经周期不同阶段对妇科腹腔镜手术后恶心呕吐的发生率无明显影响。     

腹腔镜腹股沟疝修补术后慢性疼痛的临床特征及危险因素分析

目的探讨腹腔镜腹股沟疝修补术后慢性疼痛的临床特征及危险因素。方法回顾性分析2013年1月至2017年12月期间厦门医学院附属第二医院普外肝胆外科完成的142例行腹腔镜腹股沟疝修补术患者的临床和随访资料。结果本组患者行腹腔镜腹股沟疝修补术后慢性疼痛的发生率为12.7%(18/142),其中83.3%(15/18)的患者的疼痛部位位于腹股沟区。单因素分析结果表明,接受标准量型补片、大号补片、机械性固定补片及术后并发症者的术后慢性疼痛发生率高(P0.05)。多因素分析结果表明,大号补片[OR=1.82,95%CI为(1.18,5.36),P=0.023]、机械性固定补片[OR=1.44,95%CI为(1.07,3.62),P=0.039]及术后发生并发症[OR=2.53,95%CI(1.27,7.31),P=0.011]是术后慢性疼痛的独立危险因素(P0.05)。结论腹腔镜腹股沟疝修补术后慢性疼痛的发生是多种因素共同作用的结果,尤其是与并发症及补片因素有关。     

术前高度焦虑相关致痛因子的变化及其对术后疼痛的影响

目的探讨术前高度焦虑相关致痛因子的变化及其对术后疼痛的影响。方法选择择期在全麻下行腹腔镜手术患者71例,男27例,女44例,年龄18~60岁,ASAⅠ或Ⅱ级,根据术前24h内患者状态焦虑量表评分(SAI),将患者分为高度焦虑组(SA组,SAI45,n=31)和低度焦虑组(MA组,SAI≤45,n=40),以ELISA法测定术前血浆前列腺素E_2(PGE_2)、P物质(SP)及5-羟色胺(5-HT)浓度。于术后3、6、12、24h评估患者VAS疼痛评分及24h镇痛泵按压总次数,计算致痛因子与VAS评分的相关性;术后2个月评估慢性疼痛发生情况。结果与MA组比较,SA组术后3、6、12、24h的VAS评分明显升高(P0.05),24h镇痛泵按压次数明显增多(P0.05),且术后2个月慢性疼痛发生率明显升高(P0.05);SA组术前血浆PGE_2、5-HT浓度明显高于MA组(P0.05),但SP浓度差异无统计学意义;PGE_2与术后VAS评分呈中度正相关(r_(3h)=0.54、r_(6h)=0.51、r_(12h)=0.50、r_(24h)=0.51,P0.05),5-HT浓度与术后VAS评分呈低度正相关(r_(3h)=0.30、r_(6h)=0.37、r_(12h)=0.28、r_(24h)=0.32,P0.05)。结论术前高度焦虑患者伴血浆PGE_2和5-HT浓度升高,且与术后疼痛程度呈一定的相关性;术前高度焦虑还可导致术后慢性痛发生率增加。     

医用胶与钉合固定疝补片在腹腔镜全腹膜外腹股沟 疝修补术中应用效果的Meta分析

目的:采用Meta分析方法比较腹腔镜全腹膜外腹股沟疝修补术(TEP)采用医用胶与钉合固定补片的疗效。方法:计算机检索PubMed、Embase、The Cochrane Library、Web of Science等外文数据库及中国知网、万方、维普、中国生物医学文献等中文数据库,时间限定为2018年10月前。提取数据后采用RevMan 5.3软件进行Meta分析。结果:最终纳入9项研究,共986例患者,其中医用胶组491例,钉合固定组495例。Meta分析结果显示,与钉合固定组相比,医用胶组术后第1天疼痛视觉模拟评分(VAS)较低(MD=-0.99,95%CI=-1.58～-0.41,P<0.001),术后VAS较低(MD=-1.71,95%CI=-1.84～-1.57,P<0.00001),术后麻木或异物感较少(OR=0.23,95%CI=0.07～0.75,P<0.05)。两组术后血清肿(OR=1.77,95%CI=0.99～3.16,P=0.05)、术后感染(OR=1.77,95%CI=0.51～6.19,P>0.05)、术后尿潴留(OR=0.69,95%CI=0.20～2.32,P>0.05)发生率差异均无统计学意义。结论:腹腔镜全腹膜外腹股沟疝修补术中采用医用胶固定补片,术后第1天VAS评分、术后VAS评分、麻木或异物感优于钉合固定。     

新改良Nuss手术矫治先天性心脏病术后漏斗胸的病例对照研究

目的探索新改良Nuss手术矫治先天性心脏病术后漏斗胸的效果。方法选择2011年1月至2015年3月我科先天性心脏病术后漏斗胸患儿36例(观察组),其中男22例、女14例,年龄2.8~18.0(4.5±2.2)岁。另外连续性选取2013年7~9月非先天性心脏病的漏斗胸患儿38例(对照组),男24例、女14例,年龄2.8~20.0(4.0±2.5)岁。两组患儿均行新改良Nuss手术。观察两组患者手术时间、术中出血量、术后住院时间及相关并发症。结果观察组手术时间为50~72(60.50±3.60)min,术中出血量5~10(5.82±0.35)ml,术后住院时间4~6(4.41±0.80)d。对照组手术时间为12~45(20.15±0.68)min,术中出血量3~8(4.62±0.28)ml,术后住院时间4~7(4.61±0.63)d。观察组手术时间明显长于对照组(P0.05),两组术中出血量、术后住院时间差异无统计学意义(P0.05)。两组均无心脏破裂等严重并发症。结论新改良Nuss手术治疗先天性心脏病漏斗胸安全可行、效果良好。     

高强度聚焦超声消融术治疗良性甲状腺结节疼痛评估及其影响因素

目的评估高强度聚焦超声消融(HIFU)术治疗良性甲状腺结节时疼痛的严重程度及影响因素。方法应用HIFU术治疗109例良性甲状腺结节患者。治疗前患者均接受静脉推注哌替啶和地西泮。治疗后,要求患者按照视觉模拟评分法对治疗过程中(T1)治疗后2 h(T2)及次日早晨(T3)的疼痛感受进行评估。利用二分类Logistic回归模型评估治疗过程中疼痛的相关影响因素,包括患者一般情况、结节大小、体质量指数(BMI)和治疗参数。结果在T1时患者疼痛评分中位数为65.0(0.00～100.00)。二分类Logistic回归多变量分析结果显示,T165.0时,只有较高的BMI指数(OR=1.250,95%CI 1.091～1.433,P=0.001),较大的结节体积(OR=0.889,95%CI 0.819～0.966,P=0.006)和较长的治疗时间(OR=0.885,95%CI 0.833～0.939,P0.001)是影响患者疼痛的独立影响因素。结论 HIFU术治疗良性甲状腺结节过程中,患者的BMI指数、结节大小和治疗时间是患者疼痛的独立影响因素。     

脊柱手术患者术后慢性疼痛的危险因素及对策分析

目的 探讨脊柱手术患者术后慢性疼痛的危险因素及对策分析。方法 回顾性分析2019年1月至2022年6月于本院进行子脊柱手术的患者120例的临床资料，术后随访3个月，依据是否合并慢性疼痛，分为有慢性疼痛组(44例)与无慢性疼痛组(76例)。分析术后慢性疼痛患者的疼痛分级状况，选择χ²检验对临床资料实施单因素分析，并将有统计学意义的单因素分析结果进行多元Logistic回归分析。结果 44例术后慢性疼痛患者中，32例为轻度疼痛，占比72.73%,9例为中度疼痛，占比20.45%,3例为重度疼痛，占比6.82%；单因素分析显示，特发性脊柱侧弯、术前焦虑与抑郁、术前中重度疼痛、术后3 d VAS评分>3分、出现并发症、体重较重、手术时间长、融合椎体数较多为脊柱手术患者术后慢性疼痛的影响因素，差异有统计学意义(P<0.05)；多元Logistic回归分析显示，术前中重度疼痛、术后3 d VAS评分>3分、出现并发症、融合椎体数较多为脊柱手术患者术后慢性疼痛的独立危险因素。结论 脊柱手术患者术后慢性疼痛的危险因素包括术前VAS评分大于3分、融合椎体数...     

腹壁切口疝修补术后慢性疼痛发生状况及危险因素分析

目的探讨腹壁切口疝修补术后慢性疼痛的发生状况及相关因素,以期降低术后慢性疼痛的发生率,提高患者生活质量。 方法选取2015年1月至2019年12月陕西省人民医院收治的213例腹壁切口疝患者作为研究对象。随访观察患者行腹壁切口疝修补术后1年内发生慢性疼痛的情况,将其分为发生疼痛组和未发生疼痛组,筛选出术后慢性疼痛的危险因素。 结果共有27例患者发生慢性疼痛,发生率为12.68%。单因素分析结果显示,两组性别、体质指数（BMI）、复发疝、术后切口并发症比较,差异均有统计学意义（P<0.05）。进一步行多因素Logistic回归分析显示,女性（β=1.82,OR=6.17,95% CI：1.34~28.46,P=0.020）、BMI≥24 kg/m²（β=1.04,OR=2.82,95% CI：1.09~7.32,P=0.034）、复发疝（β=1.73,OR=5.65,95% CI：1.88~17.02,P=0.002）、术后切口并发症（β=1.43,OR=4.16,95% CI：1.53~11.33,P=0.005）是术后发生慢性疼痛的独立危险因素。 结论女性、BMI≥24 kg/m²、复发疝、术后切口并发症是腹壁切口疝患者术后发生慢性疼痛的独立危险因素,因此在行切口疝修补术时要充分评估,做好预防措施,降低术后慢性疼痛的发生率。     

脊髓神经鞘瘤切除术患者术后慢性疼痛的危险因素

目的 探讨脊髓神经鞘瘤切除术患者术后慢性疼痛(CPSP)的危险因素。方法 选择2020年3月至2021年3月择期行脊髓神经鞘瘤切除术的患者161例,男75例,女86例,年龄≥18岁,ASAⅠ—Ⅲ级。采用数字评分量表(NRS)以及神经病理性疼痛量表(NPQ)评估患者术后3个月发生慢性疼痛及神经病理性疼痛的情况。根据NRS评分将患者分为两组：CPSP组(NRS≥1分)和无CPSP组(NRS=0分)。通过医院电子病历系统以及术后3个月电话随访收集临床资料,采用多因素Logistic回归分析脊髓神经鞘瘤切除术患者发生CPSP的独立危险因素。结果 发生CPSP的患者有63例(39%),其中中重度疼痛(NRS≥4分)40例(25%)。多因素Logistic回归分析结果显示,术前合并疼痛(OR=3.670,95%CI 1.034～13.025,P=0.044)以及术后应用阿片类药物(OR=2.357,95%CI 1.103～5.036,P=0.027)是发生CPSP的独立危险因素。结论 术前合并疼痛以及术后使用阿片类药物是脊髓神经鞘瘤切除术患者发生CPSP的危险因素。     

Intraoperative intercostal nerve cryoablation During the Nuss procedure reduces length of stay and opioid requirement: A randomized clinical trial

PurposeMinimally-invasive repair of pectus excavatum by the Nuss procedure is associated with significant postoperative pain, prolonged hospital stay, and high opiate requirement. We hypothesized that intercostal nerve cryoablation during the Nuss procedure reduces hospital length of stay (LOS) compared to thoracic epidural analgesia.DesignThis randomized clinical trial evaluated 20 consecutive patients undergoing the Nuss procedure for pectus excavatum between May 2016 and March 2018. Patients were randomized evenly via closed-envelope method to receive either cryoanalgesia or thoracic epidural analgesia. Patients and physicians were blinded to study arm until immediately preoperatively.SettingSingle institution, UCSF-Benioff Children's Hospital.Participants20 consecutive patients were recruited from those scheduled for the Nuss procedure. Exclusion criteria were age < 13 years, chest wall anomaly other than pectus excavatum, previous repair or other thoracic surgery, and chronic use of pain medications.Main outcomes and measuresPrimary outcome was postoperative LOS. Secondary outcomes included total operative time, total/daily opioid requirement, inpatient/outpatient pain score, and complications. Primary outcome data were analyzed by the Mann–Whitney U-test for nonparametric continuous variables. Other continuous variables were analyzed by two-tailed t-test, while categorical data were compared via Chi-squared test, with alpha = 0.05 for significance.Results20 patients were randomized to receive either cryoablation (n = 10) or thoracic epidural (n = 10). Mean operating room time was 46.5 min longer in the cryoanalgesia group (p = 0.0001). Median LOS decreased by 2 days in patients undergoing cryoablation, to 3 days from 5 days (Mann–Whitney U, p = 0.0001). Cryoablation patients required significantly less inpatient opioid analgesia with a mean decrease of 416 mg oral morphine equivalent per patient (p = 0.0001), requiring 52%–82% fewer milligrams on postoperative days 1–3 (p < 0.01 each day). There was no difference in mean pain score between the groups at any point postoperatively, up to one year, and no increased incidence of neuropathic pain in the cryoablation group. No complications were noted in the cryoablation group; among patients with epidurals, one patient experienced a symptomatic pneumothorax and another had urinary retention.Conclusions and relevanceIntercostal nerve cryoablation during the Nuss procedure decreases hospital length of stay and opiate requirement versus thoracic epidural analgesia, while offering equivalent pain control.Type of studyTreatment study.Level of evidenceLevel I.     

肛肠手术后慢性疼痛的危险因素分析

目的 探讨肛肠手术后慢性疼痛（CPSP）的危险因素。
方法 收集2018年8月至2019年10月择期行肛肠手术746例患者资料,并记录人口学特征、合并症、术前疼痛情况、围术期情况等。通过电话随访术后1、3个月时的疼痛情况,根据术后是否发生CPSP将患者分为两组：CPSP组和非CPSP组。采用多因素Logistic回归分析CPSP的危险因素。
结果 有37例（4.96％）患者发生CPSP。与非CPSP组比较,CPSP组术前合并疼痛、高血压、贫血、术后7 d VAS疼痛评分>3分、术后发生出血、睡眠障碍和便秘的比例明显升高（P<0.05）。多因素Logistic回归分析显示,术前疼痛（OR=3.022,P=0.013）、术前贫血（OR=2.235,P=0.017）、术后出血（OR=3.511,P=0.034）、术后睡眠障碍（OR=2.345,P=0.003）以及术后7 d VAS疼痛评分>3分（OR=4.323,P=0.006）是发生肛肠手术后CPSP的危险因素。
结论 肛肠手术CPSP发生率较低,术前疼痛、术前贫血、术后出血、术后睡眠障碍以及术后7 d VAS疼痛评分>3分是发生肛肠手术CPSP的危险因素。     

Next day discharge after the Nuss procedure using intercostal nerve cryoablation,intercostal nerve blocks,and a perioperative ERAS pain protocol

BackgroundThe Nuss procedure for pectus excavatum has historically been associated with significant postoperative pain, which has been the major factor contributing to hospital length of stay (LOS).MethodsA single-institution, prospective study of 40 consecutive patients undergoing Nuss bar placement for pectus excavatum between November 2019 and January 2021 was conducted to assess the effectiveness of a multimodality pain management protocol. All patients received T3-T8 intercostal nerve cryoablation (INC), T3-T8 bupivacaine intercostal nerve blocks, Exparel at the skin incisions, and management with a perioperative analgesia regimen that minimized narcotic usage. The primary outcome was LOS. Secondary outcomes included opioid use, pain scores, and time to sensory recovery.Results37/40 patients (92.5%) were discharged home on postoperative day (POD) 1, and 3/40 (7.5%) were discharged on POD 2 (mean LOS = 1.1 days). The median average postoperative pain score was 2/10. After eliminating IVPCA from our protocol, total oral morphine equivalent (OME) decreased by 73% (55.5 mg to 15 mg) with no change in pain scores or discharge timing.ConclusionsINC combined with bupivacaine intercostal nerve blocks and a pre- and post-hospital analgesia protocol facilitated discharge one day after the Nuss procedure, achieved excellent pain control, and eliminated the need for intravenous opioids.     

Reactive pectus carinatum in patients treated for pectus excavatum

Purpose

The Ravitch and minimally invasive Nuss procedures have brought widespread relief to children with pectus excavatum, chest wall deformities, over the last half century. Generally accepted long-term complications of pectus excavatum repair are typically limited to recurrence of the excavatum deformity or persistent pain. This study examines the authors' experience with patients who develop a subsequent carinatum deformity within 1 year of pectus excavatum repair.

Methods

The authors retrospectively assessed the charts of all patients diagnosed as having a carinatum deformity subsequent to treatment for pectus excavatum at a tertiary urban hospital. We noted age at original correction of pectus excavatum, time from original correction to diagnosis of carinatum deformity, age at correction of carinatum deformity, complaints before correction, methods of repair, postoperative complications, and we reviewed relevant radiography.

Results

Three patients who underwent pectus excavatum repair between January 2000 and August 2007 developed a subsequent carinatum deformity. Two patients initially underwent minimally invasive Nuss correction of pectus excavatum; 1 patient underwent the Ravitch procedure. Within 1 year of original correction and despite intraoperative achievement of neutral sternal position, a protruding anterior chest deformity resembling de novo pectus carinatum emerged in each patient; we term this condition reactive pectus carinatum. The mean age of patients undergoing initial pectus excavatum repair was 13 years (range, 11-16 years). The pathophysiology of this reactive lesion is not well understood but is thought to originate from reactive fibroblastic stimulation as a result of sternal manipulation and bar placement. Patients who underwent Nuss correction initially were managed with early bar removal. Two of the patients eventually required surgical resection of the carinatum deformity at a time interval of 3 to 6 years after initial excavatum repair. In one patient, the carinatum deformity resolved spontaneously. Neutral chest position and absence of dyspenic symptoms were achieved in all patients.

Conclusions

Reactive pectus carinatum is functionally encumbering and a poor cosmetic complication of either the Ravitch or minimally invasive Nuss procedures. Our experience with reactive pectus carinatum introduces the importance of postoperative vigilance even in patients without underlying fibroelastic disease. Examination of the chest with attention to the possibility of an emerging carinatum deformity, particularly in the first 6 postoperative months, is paramount. A telephone call to the patient at 3 months may be a useful adjunct to clinic visits. An optimal long-term result may be achieved through a combination of early Nuss bar removal or postpubertal pectus carinatum repair.     

疼痛手册在Nuss术后患者家庭护理中的应用

目的探讨疼痛手册在微创漏斗胸矫形术(Nuss术)后家庭护理中的应用效果。方法将70例出院的Nuss术患者随机分为对照组和观察组各35例,对照组实施常规出院指导,观察组在此基础上发放疼痛手册并告知填写方法,护士在患者出院次日即开始进行电话回访,指导患者对照手册避免可能导致剧痛的行为,介绍疼痛处理方法,监督体疗锻炼。结果术后3个月观察组体疗锻炼依从性及胸廓矫形效果显著优于对照组,疼痛体验显著低于对照组(均P<0.01)。结论运用疼痛手册能有效促进Nuss术后患者康复,保证胸廓矫形效果。     

Same day discharge for pectus excavatum—is it possible?

PurposeThe use of intercostal nerve cryoablation (INC) has been an effective modality for treating pain in patients undergoing pectus excavatum (PE) repair. This study sought to evaluate if PE patients undergoing Nuss procedures with INC and intercostal nerve block (INB) could safely be discharged the same day of surgery.MethodsA prospective study with IRB approval of 15 consecutive patients undergoing PE Nuss repair with INC, INB, and an enhanced recovery after surgery (ERAS) protocol was conducted. The primary outcome measure was hospital length of stay (LOS) in hours. Secondary variables included same day discharge, postoperative complications, emergency department (ED) visits, urgent care (UC) visits, opioid use, and return to the operating room (OR).ResultsLOS averaged 11.9 h amongst 15 patients. Ten patients (66.7%) went home on postoperative day (POD) 0, and the rest went home on POD 1. No patients stayed in the hospital due to pain. Reasons for failure to discharge included urinary retention, drowsiness, vomiting, and anxiety, but not pain. No patients were readmitted to the ED. One patient visited UC for constipation. One patient had bar migration requiring return to the OR for revision. Ten (66.7%) patients did not use opioids after discharge.ConclusionsSame day discharge is feasible and safe in PE patients undergoing Nuss procedure with INC and INB. INC with INB can adequately control pain without significant complications. Same day discharge can be safely considered for PE patients undergoing Nuss procedure with INC with INB.Type of studyPrognosis studyLevel-of-evidence ratingLevel II     

Improvement in Polysomnographic Objective Sleep Quality in Adults with Pectus Excavatum After the Nuss Procedure

Background

Patients with pectus excavatum have a poorer subjective sleep quality and quality of life than the general population. The Nuss procedure has been shown to improve these patients’ quality of life, but data regarding their postoperative sleep quality are lacking. We aimed to evaluate the objective sleep quality of adults with pectus excavatum before and after the Nuss procedure.

Methods

Twenty-eight participants completed this study. Epworth Sleepiness Scale (ESS) scores for daytime sleepiness, Pittsburgh Sleep Quality Index (PSQI) scores for subjective sleep quality, and overnight polysomnography for objective sleep quality were evaluated before and 6 months after the Nuss procedure.

Results

Subjective sleep quality improved after the Nuss procedure. The median PSQI score decreased from 7 [interquartile range (IQR): 5; 9] to 5 (IQR: 4; 7, p = 0.029); the median percentage of poor PSQI sleep quality decreased from 64.3 to 35.7% (p = 0.048). The median percentage of rapid eye movement sleep significantly increased after surgery [15.6% (IQR: 12.2%; 19.8%) vs. 20.4% (IQR: 14.5%; 24.9%), p = 0.016]. Sleep interruptions also improved, with the median arousal index decreasing from 9.5 (IQR: 4.8; 18.2) to 8.2 (IQR: 4.3; 12.1; p = 0.045). However, there was no significant change in ESS scores after surgery (p = 0.955).

Conclusions

Pectus excavatum may be associated with poor subjective and objective sleep quality in adults, and the condition may improve after the Nuss procedure. For adults with pectus excavatum who report poor subjective sleep quality, polysomnography should be considered to assess their preoperative and postoperative sleep condition.

     

Bilateral PECS II Block is Associated with Decreased Opioid Consumption and Reduced Pain Scores for up to 24 hours After Minimally Invasive Repair of Pectus Excavatum (Nuss Procedure): A Retrospective Analysis

Objective(s)Compared to the open surgical technique, the minimally invasive repair of pectus excavatum (MIRPE; Nuss procedure) is a thoracoscopic technique designed to minimize intraoperative tissue damage. It still causes severe postoperative pain due to the insertion and pressure of the retrosternal bar used to raise the sternum and stabilize the chest. This study aimed to identify associations between ultrasound-guided PECS-II block and postoperative analgesia after the Nuss procedure.DesignA retrospective cohort studySettingSingle-center, training and research hospital affiliated with a universityParticipantsFrom Jan 1, 2018 to Nov 15, 2021, 171 consecutive patients were identified who underwent MIRPE surgery under general anesthesia. All patients received intravenous (I) patient-controlled analgesia (PCA) with or without PECS-II blocks for postoperative analgesia. One hundred twenty-five patients who met the inclusion criteria were evaluated.InterventionsDemand-only morphine intravenous PCA was used for postoperative pain management in the PECS and control groups. Bilateral PECS-II block with 0.25% bupivacaine was performed in to the PECS group.Measurements and main resultsThe primary outcome was postoperative opioid consumption, calculated as mg/kg of IV morphine. Secondary outcomes included Numeric Rating Scale (NRS) pain scores at rest (static) and with movement (dynamic) recorded 1, 4, 8, 12, 24 h after surgery. Postoperative morphine consumption was significantly lower in the PECS group than in the control group over the first 24 hours postoperatively: 0.325 mg/kg vs. 0.425 mg/kg (p<0.001). Static and dynamic NRS values were significantly lower in the PECS group for the first 12 postoperative hours (p <0.05).ConclusionsBilateral PECS-II block is associated with decreased pain scores for up to 12 hours, and with decreased opioid consumption for up to 24 hours, following minimally invasive repair of pectus excavatum (Nuss procedure) in adolescents. PECS-II block in this context has not been previously described.     

胸膜外Nuss手术与Nuss手术对比研究

目的 前瞻性对比胸膜外Nuss手术和Nuss手术的安全性和可行性.方法 2008年7月至2009年6月252例行Nuss手术者,排除漏斗胸复发、有合并症同期手术、大于13岁、广泛凹陷使用双支撑架和极重度和严重非对称性者,余131例随机分两组,62例胸膜外Nuss手术组和69例Nuss手术组.比较两种术式同手术期情况、并发症和手术效果,并观察胸膜外组钢板是否确在胸膜外.结果 131例均顺利完成手术,在两组年龄、Haller指数差异无统计学意义的前提下,手术优良率、手术时间、术中出血量和出院时间差异亦均无统计学意义.随访14～26个月,无复发及远期并发症,两组并发症各3.例,差异无统计学意义.胸膜外组32例破入胸腔.结论 胸膜外Nuss手术是安全可行的,但与Nuss手术组在手术时间、术中出血、出院时间和手术效果上无任何优势,且不容易观察到对侧胸腔情况,手术方法不容易掌握和推广.

Abstract：

Objective To compare the safety and feasibility of thoracoscopic extrapleural Nuss procedure with traditional intrapleural Nuss procedure. Methods Total 252 patients with pectus excavatum received Nuss surgery from July 2008 to June 2009 in Beijing children' s hospital. Patients had following condition were excluded; (1) recurrent pectus excavatum; (2) complicated with other diseases, and need simultaneous surgery; (3) older than 13-year-old; (4) extensive depression, and need two Nuss bar; or (5) extreme severe or severe unsymmetric. 131 cases were selected in our study and they were randomly divided into two groups, thoracoscopic extrapleural Nuss procedure ( n = 62 ) and traditional intrapleural Nuss procedure ( n =69). Perioperative information, postoperative complications, effectiveness and the location of the Nuss bar were compared between two groups. Results All the 131 patients had completed the procedure successfully. There were no significant differences in age, Haller index; surgical effects, operation time, blood loss, and hospital stay, between two groups. Postoperative complications between the two groups are not significant. 131 patients were followed up from 14 to 26 months, and no recurrence and long-term complications occurred. About more than half cases of extrapleural Nuss procedure group were break the pleural into thoracic cavity. Conclusion Both extrapleural and intrapleural Nuss procedure are safe and effective for pectus excavatum, but extrapleural Nuss procedure have no advantage to the intrapleural Nuss procedure, also it' s hard to observe the other side of thoracic cavity during the surgery, and not easy to grasp and to promote.