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J Thorac Cardiovasc Surg 2010;140:39-44
© 2010 The American Association for Thoracic Surgery

General Thoracic Surgery

Double-bar application decreases postoperative pain after the Nuss procedure

^a Department of Plastic and Reconstructive Surgery, School of Medicine, Keio University, Tokyo, Japan
^b Department Cardiovascular Surgery, School of Medicine, Keio University, Tokyo, Japan
^c Department of Plastic Surgery, Shanghai Second Military Medical College, ChangZheng Hospital, Shanghai, China
^d TOYOTA Central Research Institute, Nippon, Japan
^e Nippon Institute of Technology, Nippon, Japan

Received for publication June 19, 2009; revisions received November 6, 2009; accepted for publication December 13, 2009.

^_* Address for reprints: Tomohisa Nagasao, MD, Department of Plastic and Reconstructive Surgery, Keio University Hospital, Shinjuku-Ward Shinanomachi 35, Tokyo, Japan. (Email: nagasao{at}sc.itc.keio.ac.jp).

Objective: This biomechanical study aims to elucidate whether additional bar application increases postoperative pain after the Nuss procedure for pectus excavatum.

Methods: Clinical evaluation: The intensity of postoperative pain was compared between patients for whom a single-bar was used (single-bar group: n = 14) and those for whom double bars (double-bar group: n = 10) were used to correct the thoracic deformity. The evaluation was performed by referring to the frequency with which local anesthetics were self-injected in a patient-controlled anesthetic system and how many days were needed for the patients to resume ambulation. Theoretical evaluation: An original simulation system for the Nuss procedure was developed by producing 3-dimensional finite element analysis models from computed tomographic data of patients with pectus excavatum. With this system, single-bar and double-bar placement was simulated separately for the thorax models of the double-bar group. The stresses occurring on the thoraces were then compared between the two situations.

Results: Clinical evaluation: Self-injection of local anesthetic was more frequent for the single-bar group than for the double-bar group; single-bar patients restarted ambulation later than the double-bar group. Theoretical evaluation: Stresses on the thoraces were smaller when double bars were applied than when a single bar was applied.

Conclusions: Performing double-bar placement decreases postoperative pain. Therefore, surgeons should not hesitate to perform double-bar correction in patients in whom the deformity extends to multiple intercostal spaces, requiring correction of the thorax shape at multiple sites.