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Randomized trial of epidural vs. subcutaneous catheters for managing pain after modified Nuss in adults

	author = {Dawn E. Jaroszewski and M’hamed Temkit and MennatAllah M. Ewais and Todd C. Luckritz and Joshua D. Stearns and Ryan C. Craner and Brantley D. Gaitan and Harish Ramakrishna and Christopher A. Thunberg and Ricardo A. Weis and Kelly M. Myers and Marianne V. Merritt and David M. Rosenfeld},
	title = {Randomized trial of epidural  vs . subcutaneous catheters for managing pain after modified Nuss in adults},
	journal = {Journal of Thoracic Disease},
	volume = {8},
	number = {8},
	year = {2016},
	keywords = {},
	abstract = {Background: Minimally invasive repair of pectus excavatum (MIRPE) is now performed in adults. Managing adult patients’ pain postoperatively has been challenging due to increased chest wall rigidity and the pressure required for supporting the elevated sternum. The optimal pain management regimen has not been determined. We designed this prospective, randomized trial to compare postoperative pain management and outcomes between thoracic epidural analgesia (TEA) and bilateral subcutaneous infusion pump catheters (On-Q). 
Methods: Patients undergoing MIRPE (modified Nuss) underwent random assignment to TEA or On-Q group. Both groups received intravenous, patient-controlled opioid analgesia, with concomitant delivery of local anesthetic. Primary outcomes were length of stay (LOS), opioid use, and pain scores.
Results: Of 85 randomly assigned patients, 68 completed the study [52 men, 76.5%; mean (range) age, 32.2 (20.0–58.0) years; Haller index, 5.9 (range, 3.0-26.7)]. The groups were equally matched for preoperative variables; however, the On-Q arm had more patients (60.3%). No significant differences were found between groups in mean daily pain scores (P=0.52), morphine-equivalent opioid usage (P=0.28), or hospital stay 3.5 vs. 3.3 days (TEA vs. On-Q; P=0.55). Thirteen patients randomized to TEA refused the epidural and withdrew from the study because they perceived greater benefit of the On-Q system. 
Conclusions: Postoperative pain management in adults after MIRPE can be difficult. Both continuous local anesthetic delivery by TEA and On-Q catheters with concomitant, intravenous, patient-controlled anesthesia maintained acceptable analgesia with a reasonable LOS. In our cohort, there was preference for the On-Q system for pain management.},
	issn = {2077-6624},	url = {}