Expedited Recovery Pain Management Pathway for Minimally Invasive Repair of Pectus Excavatum (MIRPE)

• DOI: 10.32873/unmc.dc.gmerj.5.1.002
• Publication Date: 2023-07-06T13:57:16Z
• Authors: Tecos, Maria E; Goeller, Jessica; Cusick, Robert; Raynor, Stephen
• Keywords: Nuss repair; enhanced recovery; pectus excavatum; pain management; Medicine and Health Sciences; Surgery; Higher Education

Introduction: Pectus Excavatum (PEX) is the most common anterior chest wall deformity. While minimally invasive repair of pectus excavatum (MIRPE) has improved perioperative outcomes, there continue to be opportunities to optimize postoperative pain management and reduce length of stay (LOS). We compared the impact of a multimodal expedited protocol utilizing a combination of systemic and regional analgesia (with single shot paravertebral truncal blocks), along with coping techniques (such as meditation), and physical therapy, with systemic analgesia on LOS and opioid requirements. Methods: 51 patients underwent MIRPE with an expedited recovery protocol in comparison with 112 historical control patients at a single center over 18 years. LOS and opioid analgesic morphine milliequivalent (MME) were compared. Data were stratified for age, biological sex, and Haller index (HI) to identify potential confounding variables. Results: There was no difference in age or HI between cohorts. LOS was reduced by 59.1% in the enhanced recovery group compared to the historic group (1.8 days vs 4.4 days, SD=0.5664 and 0.9503 respectively, P< 0.0001). On postoperative day (POD)1, the expedited patients required an average of 100.7 MME (IQR 61.65-124.3) compared to 123.6 MME (IQR 79.5-161.1) for historic control patients (P=0.04). Cumulative MME for POD0-2 was 34.8% less in the expedited recovery patients (P= Conclusions: This MIRPE expedited recovery pain protocol using a standardized multimodal analgesia strategy and regional anesthesia is a safe and effective therapeutic plan that results in decreased opioid analgesic requirements and a significantly decreased LOS.