title: Epidural vs patient-controlled analgesia for postoperative pain after pectus excavatum repair: a prospective, randomized trial.
abstract: OBJECTIVE
  Management of postoperative pain is a challenge after the minimally invasive repair of pectus excavatum. Pain is usually managed by either a thoracic epidural or patient-controlled analgesia with intravenous narcotics. We conducted a prospective, randomized trial to evaluate the relative merits of these 2 pain management strategies.
  
  
  METHODS
  After obtaining permission/assent (Institutional Review Board no. 06 08 128), patients were randomized to either epidural or patient-controlled analgesia with fixed protocols for each arm. The primary outcome variable was length of stay with a power of .8 and α of .05.
  
  
  RESULTS
  One hundred ten patients were enrolled. There was no difference in length of stay between the 2 arms. A longer operative time, more calls to anesthesia, and greater hospital charges were found in the epidural group. Pain scores favored epidural for the few days and favored patient-controlled analgesia thereafter. The epidural catheter could not be placed or was removed within 24 hours in 12 patients (22%).
  
  
  CONCLUSIONS
  There is longer operating room time, increase in calls to anesthesia, and greater hospital charges with epidural analgesia after repair of pectus excavatum. Pain scores favor the epidural approach early in the postoperative course and patient-controlled analgesia later.
authors.affiliation: Department of Surgery, The Children's Mercy Hospital, Kansas City, MO 64108, USA. sspeter@cmh.edu
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Weesner
authors.forename: Eric E
authors.initials: EE
authors.lastname: Weissend
authors.forename: Susan W
authors.initials: SW
authors.lastname: Sharp
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Valusek
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Sharp
authors.forename: Charles L
authors.initials: CL
authors.lastname: Snyder
authors.forename: George W
authors.initials: GW
authors.lastname: Holcomb
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ostlie
mesh_terms: D000293:Adolescent; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies