Postoperative consumption of opioid analgesics following correction of pectus excavatum is influenced by pectus severity: a single-centre study of 236 patients undergoing minimally invasive correction of pectus excavatum.
OBJECTIVE
Surgical correction of pectus excavatum (PE) is primarily performed to achieve cosmetic and psychological benefits for the patient. Minimally invasive repair of PE is often associated with severe postoperative pain. This study estimates the effect of the severity of PE on the postoperative consumption of opioid analgesics following this procedure to optimise pain management.


METHODS
A retrospective study was conducted on 236 consecutive patients undergoing minimally invasive repair of PE from 2005 to 2008. The collected data included depth of preoperative pectus excavation, patient demographics, peri- and postoperative information, including data on pain management. The consumption of opioid analgesics was registered after discontinuation of epidural analgesia and other types of opioid analgesics used during the study period were converted to morphine equivalents. Multiple linear regression analysis was performed to estimate the effect of the severity of PE on the postoperative consumption of opioid analgesics and to adjust for potential confounding.


RESULTS
The total morphine consumption following minimally invasive repair of PE ranged between 20 and 370 mg day(-1). Multiple linear regression analysis explained approximately 30% of the variation in daily morphine consumption (R-squared=0.2957). There was a significant positive linear relationship between pectus severity and the daily consumption of morphine. Thus, postoperative consumption of morphine increased by 6% (95% confidence interval (CI): 0.3-11%) when preoperative PE depth deteriorated with 1cm.


CONCLUSIONS
This study confirms that pectus severity has a significant impact on the consumption of opioid analgesics following minimally invasive repair of PE. We conclude that knowledge of pectus severity might be useful in the prediction of the expected morphine consumption in future patients, especially during the critical transition period from epidural analgesia to oral analgesia.
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark. kasper.grosen@ki.au.dk
Kasper
K
Grosen
Mogens
M
Pfeiffer-Jensen
Hans K
HK
Pilegaard
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015360:Analgesia, Epidural / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002648:Child; D004334:Drug Administration Schedule; D004812:Epidemiologic Methods; D005260:Female; D005660:Funnel Chest / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D055815:Young Adult
D000701:Analgesics, Opioid