Postoperative Pain Outcomes after Nuss Procedures: Comparison of Epidural Analgesia, Continuous Infusion of Local Anesthetic, and Preoperative Self-Hypnosis Training

Background/Purpose: The Nuss procedure to correct pectus excavatum is associated with severe postoperative pain. The purpose of this retrospective study was to compare pain management outcomes of thoracic epidural analgesia and continuous infusion of local anesthetic (CILA) with and without preoperative self-hypnosis training (SHT) after Nuss procedure (4 treatment groups). Methods: Between February 2010 and December 2013, 24 of 53 adolescents who underwent Nuss procedure received SHT. Of these, 16 received thoracic epidural analgesia and 8 received CILA postoperatively. Of the 29 patients who did not receive SHT, 19 received thoracic epidural analgesia and 10 received CILA. All patients received intravenous patient-controlled opioid analgesia and intravenous nonsteroidal anti-inflammatory drugs (IVNSAIDs) and then were transitioned to oral opioids and NSAIDs. Postoperative mean and maximum pain scores, opioid (morphine equivalents) use and side effects, and hospital length of stay (LOS) were compared between groups. Results: Patients who received SHT reported lower mean (P =.0047) and maximum (P =.0028) pain scores and used less morphine equivalents/hour over time (P =.046) compared to patients who did not receive SHT. Patients who received thoracic epidural analgesia reported lower mean (P =.0092) and maximum (P =.0083) postoperative pain scores and used more morphine equivalents/hour (P =.01) compared to those who received CILA. In addition, patients who received SHT and CILA had shorter LOS (P =.0013) than patients who received thoracic epidural analgesia without SHT. Conclusions: SHT before pectus excavatum repair by Nuss procedure results in less postoperative pain and requires less morphine equivalents over time for postoperative pain management. Opioid-sparing CILA, when paired with SHT, results in shorter LOS.