title: Postoperative opioid analgesic use after Nuss versus Ravitch pectus excavatum repair.
abstract: OBJECTIVE
  Anticipated postoperative pain may affect procedure choice in patients with pectus excavatum. This study aims to compare postoperative pain in patients undergoing Nuss and Ravitch procedures.
  
  
  METHODS
  A 5year retrospective review was performed. Data on age, gender, Haller index, procedure, pain scores, pain medications, and length of hospital stay were collected. Total inpatient opioid administration was converted to morphine equivalent daily dose per kilogram (MEDD/kg) and compared between procedures.
  
  
  RESULTS
  One hundred eighty-one patients underwent 125 (69%) Nuss and 56 (31%) Ravitch procedures. Ravitch patients were older (15.7 yo vs 14.6 yo, p=0.004) and had a higher Haller index (5.21 vs 4.10, p=<0.001). Nuss patients had higher average daily pain scores, received 25% more opioids (MEDD/kg 0.66 vs. 0.49, p=<0.001), and received twice as much IV diazepam/kg. In the multivariate analysis, higher MEDD/kg correlated with both the Nuss procedure and older age in the Nuss group. Opioid administration did not correlate with Haller index or Nuss bar fixation technique. Increased NSAID administration did not correlate with lower use of opioids.
  
  
  CONCLUSIONS
  The Nuss procedure is associated with greater postoperative pain compared to the Ravitch procedure. Opioid use is higher in older patients undergoing the Nuss procedure, but is not associated with severity of deformity.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Papic
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA; Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: S Maria E
authors.initials: SM
authors.lastname: Finnell
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA.
authors.forename: Abby M
authors.initials: AM
authors.lastname: Howenstein
authors.affiliation: Department of Pharmacy, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA.
authors.forename: Francine
authors.initials: F
authors.lastname: Breckler
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA. Electronic address: LEYS@surgery.wisc.edu.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Leys
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002648:Child; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D007275:Injections, Intravenous; D007902:Length of Stay / Q000639:trends; D008297:Male; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D013905:Thoracoplasty / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: Morphine equivalent daily dose; Nuss procedure; Opioid; Pain; Pectus excavatum; Ravitch procedure