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J Thorac Cardiovasc Surg 2007;134:865-870
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Superior postoperative pain relief with thoracic epidural analgesia versus intravenous patient-controlled analgesia after minimally invasive pectus excavatum repair

^a Medical Research Society, Vienna, Danube City; Department of Anesthesiology and Intensive Care, Sozialmedizinisches Zentrum Ost-Donauspital, Vienna, Austria
^b Department of Pediatric Surgery, Sozialmedizinisches Zentrum Ost-Donauspital, Vienna, Austria
^c Charité–University of Medicine Berlin, Institute for Clinical Epidemiology, Berlin, Germany
^d Department of Special Anesthesiology and Pain Therapy, Vienna Medical University, General Hospital Vienna, Vienna, Austria.

Received for publication November 24, 2006; revisions received March 3, 2007; accepted for publication May 11, 2007.

^_* Address for reprints: Thomas Weber, MD, DEEA, Medical Research Society, Vienna, Danube City, at the Sozialmedizinisches Zentrum Ost-Donauspital, Department of Anesthesiology and Intensive Care, Langobardenstrasse 122, A-1220 Vienna, Austria. (Email: thomas.weber{at}wienkav.at).

Objective: Minimally invasive pectus excavatum repair is a common and painful surgical procedure in children and adolescents. Adequate postoperative pain therapy is important far beyond the immediate postoperative period because sensitization to painful stimuli can cause chronic pain or higher pain levels during subsequent surgical procedures. Although data in adults favor thoracic epidural anesthesia for pain control in thoracotomy, data for adolescents and children are scarce. We tested the hypothesis that pain relief with thoracic epidural analgesia was superior to that with intravenous patient-controlled analgesia after minimally invasive pectus excavatum repair in children and adolescents.

Methods: We performed a prospective randomized trial with adolescents who had undergone minimally invasive pectus excavatum repair to compare postoperative pain using two different postoperative pain therapy settings: intravenous patient-controlled analgesia (n = 20) with morphine versus continuous thoracic epidural analgesia (n = 20) with 0.2% ropivacain containing 2 µg/mL fentanyl.

Results: Forty patients (32 male and 8 female patients) aged 10 to 28 years were studied. The thoracic epidural analgesia group showed lower pain scores (P < .0001) and required less additional pain medication in conjunction with greater well-being postoperatively (P < .0001) compared with patients receiving patient-controlled intravenous morphine. There was no significant difference regarding the incidence of sedation (P = .38), nausea (P = .10), and pruritus (P = .72) in both groups.

Conclusions: For adolescents undergoing minimally invasive pectus excavatum repair, thoracic epidural analgesia was superior to intravenous patient-controlled analgesia for postoperative analgesia, resulting in lower postoperative pain scores in conjunction with greater well-being.