title: Long-term patient perception of pain control experience after participating in a trial between patient-controlled analgesia and epidural after pectus excavatum repair with bar placement.
abstract: BACKGROUND
  Pain control is the dominant management issue after bar placement for pectus excavatum. We previously conducted a prospective, randomized trial comparing patient-controlled analgesia (PCA) to thoracic epidural (EPI) documenting similar objective outcomes. Our impression is that the subjective cognitive experience differs between the groups, which impacts trial results interpretation. Therefore, we conducted a survey to ascertain patient recollection and impression of their experience.
  
  
  METHODS
  By telephone questionnaire, yes/no questions included early course recall, anxiety, if they would choose the same arm, do the operation again, or recommend it to friends. Qualitative questions included description, location, and time of peak pain. The graded question addressed severity of pain (1-5).
  
  
  RESULTS
  We contacted 27 EPI and 38 PCA patients with a median follow-up of 3.2 y. The majority (~/= 85%) of both groups remembered the first 2 d. Mean pain severity was 3.0 in both groups (3 = bad, but tolerable). Description, location, and time of peak pain responses did not differ. Anxiety was reported by 30% of EPI group and 18% of PCA group (P = 0.37). Approximately 15% of both groups still think about the pain. No differences were seen in nausea, emesis, constipation, itching, or sleepiness. Most patients would choose the same group (87% PCA, 81% EPI, P = 0.73), have the operation again (87% PCA, 74% EPI, P = 0.21), and recommend the operation to friends (100% PCA, 96% EPI, P = 0.42).
  
  
  CONCLUSIONS
  Long-term recall after repair of pectus excavatum with bar placement does not substantially differ between those managed with an epidural or PCA.
authors: Department of surgery, The Children's Mercy Hospital, Kansas City, Missouri.
authors: Alessandra C
authors: AC
authors: Gasior
authors: Kathryn A
authors: KA
authors: Weesner
authors: E Marty
authors: EM
authors: Knott
authors: Ashwini
authors: A
authors: Poola
authors: Shawn D
authors: SD
authors: St Peter
mesh_terms: D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000627:therapeutic use; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000601:surgery*; D007407:Interviews as Topic; D019637:Orthopedic Procedures; D010098:Oxycodone / Q000627:therapeutic use; D017288:Pain Threshold / Q000523:psychology*; D010149:Postoperative Pain / Q000188:drug therapy* / Q000523:psychology*; D017060:Patient Satisfaction; D011446:Prospective Studies; D013995:Time
chemical_list: D000701:Analgesics, Opioid; D010098:Oxycodone
keywords: Epidural; PCA; Pain control; Pectus bar; Pediatric