title: Multimodal anesthesia with the addition of methadone is superior to epidural analgesia: A retrospective comparison of intraoperative anesthetic techniques and pain management for 124 pediatric patients undergoing the Nuss procedure.
abstract: BACKGROUND
  The Nuss procedure corrects pectus excavatum by forceful displacement of the sternum with metal bars. Optimal pain management remains a challenge. Mutimodal anesthesia alleviates pain through blockade of multiple nociceptive and inflammatory pain receptors.
  
  
  METHODS
  A retrospective chart review of anesthetic and postoperative mangement of 125 children undergoing the Nuss procedure was conducted. Anesthetic mangement strategies were analyzed in four groups: opioid during general anesthesia (GA), epidural with general anesthesia (Epidural), multimodal anesthesia (MM), and multimodal anesthesia with methadone (MM+M). Data collection included total opioid use (as equivalent milligrams of morphine (Mmg)), pain scores, length of stay (LOS), and adverse effects.
  
  
  RESULTS
  Total opioid use varied by group (median, IQR (in Mg)): Epidural 213 [149, 293], GA 179 [134, 298], MM (150 [123, 281]), and MM+M (106 [87, 149]), as did severe pain (in minutes): Epidural (208 [73, 323]), GA (115 [7, 255]), MM (54 [0, 210]), and MM+M (49 [0, 151]). LOS was shortest for the MM+M group (MM+M=3.8+1.0days; MM=4.5+1.3days; GA=4.9+1.4days, Epidural=5.5+2.3days).
  
  
  CONCLUSIONS
  Multimodal anesthesia is associated with less postoperative pain and shorter LOS compared to epidural or traditional anesthetic techniques for the Nuss procedure. Multimodal anesthesia with a single intraoperative dose of methadone was associated with lowest total opioid use, time with uncontrolled pain, and shortest LOS.
authors.affiliation: Valley Anesthesiology Consultants, Phoenix Children's Hospital, Surgery and Pain Management, Phoenix, AZ, USA. Electronic address: rsinghal@valley.md.
authors.forename: Neil R
authors.initials: NR
authors.lastname: Singhal
authors.affiliation: Valley Anesthesiology Consultants, Phoenix Children's Hospital, Surgery and Pain Management, Phoenix, AZ, USA.
authors.forename: John
authors.initials: J
authors.lastname: Jones
authors.affiliation: Valley Anesthesiology Consultants, Phoenix Children's Hospital, Surgery and Pain Management, Phoenix, AZ, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Semenova
authors.affiliation: Valley Anesthesiology Consultants, Phoenix Children's Hospital, Surgery and Pain Management, Phoenix, AZ, USA.
authors.forename: Amber
authors.initials: A
authors.lastname: Williamson
authors.affiliation: Valley Anesthesiology Consultants, Phoenix Children's Hospital, Surgery and Pain Management, Phoenix, AZ, USA.
authors.forename: Katelyn
authors.initials: K
authors.lastname: McCollum
authors.affiliation: Valley Anesthesiology Consultants, Phoenix Children's Hospital, Surgery and Pain Management, Phoenix, AZ, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Tong
authors.affiliation: Valley Anesthesiology Consultants, Phoenix Children's Hospital, Surgery and Pain Management, Phoenix, AZ, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Jerman
authors.affiliation: Valley Anesthesiology Consultants, Phoenix Children's Hospital, Surgery and Pain Management, Phoenix, AZ, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Notrica
authors.affiliation: Valley Anesthesiology Consultants, Phoenix Children's Hospital, Surgery and Pain Management, Phoenix, AZ, USA.
authors.forename: Hayden
authors.initials: H
authors.lastname: Nguyen
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000767:Anesthesia, Epidural / Q000379:methods*; D000768:Anesthesia, General; D000777:Anesthetics / Q000008:administration & dosage*; D005260:Female; D005660:Funnel Chest / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D000777:Anesthetics
keywords: Methadone; Multimodal anesthesia; Nuss procedure; Pain management; Pectus excavatum