Double-bar application decreases postoperative pain after the Nuss procedure.
OBJECTIVE
This biomechanical study aims to elucidate whether additional bar application increases postoperative pain after the Nuss procedure for pectus excavatum.


METHODS
Clinical evaluation: The intensity of postoperative pain was compared between patients for whom a single-bar was used (single-bar group: n = 14) and those for whom double bars (double-bar group: n = 10) were used to correct the thoracic deformity. The evaluation was performed by referring to the frequency with which local anesthetics were self-injected in a patient-controlled anesthetic system and how many days were needed for the patients to resume ambulation. Theoretical evaluation: An original simulation system for the Nuss procedure was developed by producing 3-dimensional finite element analysis models from computed tomographic data of patients with pectus excavatum. With this system, single-bar and double-bar placement was simulated separately for the thorax models of the double-bar group. The stresses occurring on the thoraces were then compared between the two situations.


RESULTS
Clinical evaluation: Self-injection of local anesthetic was more frequent for the single-bar group than for the double-bar group; single-bar patients restarted ambulation later than the double-bar group. Theoretical evaluation: Stresses on the thoraces were smaller when double bars were applied than when a single bar was applied.


CONCLUSIONS
Performing double-bar placement decreases postoperative pain. Therefore, surgeons should not hesitate to perform double-bar correction in patients in whom the deformity extends to multiple intercostal spaces, requiring correction of the thorax shape at multiple sites.
Nagaso
Tomohisa
T
Department of Plastic and Reconstructive Surgery, School of Medicine, Keio University, Tokyo, Japan. nagasao@sc.itc.keio.ac.jp
Miyamoto
Junpei
J
Kokaji
Kiyokazu
K
Yozu
Ryohei
R
Jiang
Hua
H
Jin
HongMei
H
Tamaki
Tamotsu
T
D000293:Adolescent; D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage; D001696:Biomechanical Phenomena; D002648:Child; D003198:Computer Simulation; D005260:Female; D020342:Finite Element Analysis; D005660:Funnel Chest / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008953:Models, Anatomic; D009983:Orthopedic Equipment; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D020127:Recovery of Function; D012646:Self Administration; D013314:Stress, Mechanical; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016138:Walking; D055815:Young Adult
D000779:Anesthetics, Local