Pectus excavatum is a congenital condition characterized by the breastbone sinking into the chest. It can be corrected in children via minimally invasive surgery but controlling pain after the procedure can be problematic.
In a study presented at the annual meeting of the American Pediatric Surgical Association, researchers detailed how a more effective way of controlling pain has been developed, allowing children to not only experience better pain relief but also reduce opioid painkiller use and shorten hospital stays.
Different methods of pain control have been explored before but researchers have discovered that a non-narcotic nerve blocker known as a paravertebral blockade can be used to promote more efficient pain control in pectus excavatum patients.
"It's better than an epidural, because it's reliable, and kids can go home with it. For the first time, we consistently deliver on our promise to minimize pain," said Dr. Christopher Moir, a Mayo Clinic Children's Center thoracic and pediatric surgeon and the study's co-author.
To assess how effective using a paravertebral blockade can be, researchers focused on pectus excavatum patients who underwent the Nuss procedure. From 2010 to 2015, they worked with 132 cases, 114 of which received paravertebral catheters and were continuously given infusions between two and five days after going home and 18 were given epidurals.
Based on their findings, the researchers saw that those patients who got paravertebral catheters cut back, on average, a day and a half from their hospital stay and significantly used less opioids to manage pain.
Deformities affecting chest walls are actually common, with pectus excavatum being the most frequently reported condition. The sunken breastbone is easily noticed at birth and usually worsens during adolescence. At the least, the condition can make children self-conscious about their appearance. At the worst, it can impede proper functions of the lungs and heart.
Epidurals are the standard when it comes to managing pain after a pectus excavatum procedure but their use is ceased before a child leaves the hospital, which results in persistent and severe pain.
Previous Mayo Clinic research shows that paravertebral blockades are also effective in managing pain after procedures geared toward addressing shoulder injuries, hernia repair and breast cancer.
