Multimodal anesthesia with the addition of methadone is superior to epidural analgesia: A retrospective comparison of intraoperative anesthetic techniques and pain management for 124 pediatric patients undergoing the Nuss procedure

详细信息    查看全文

• 作者：Neil R. Singhal ; ^{rsinghal@valley.md" class="auth_mail" title="E-mail the corresponding author} ; John Jones ; Janet Semenova ; Amber Williamson ; Katelyn McCollum ; Dennis Tong ; Jonathan Jerman ; David M. Notrica ; Hayden Nguyen
• 关键词：Multimodal anesthesia ; Methadone ; Nuss procedure ; Pectus excavatum ; Pain management
• 刊名：Journal of Pediatric Surgery
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：51
• 期：4
• 页码：612-616
• 全文大小：295 K

文摘

The Nuss procedure corrects pectus excavatum by forceful displacement of the sternum with metal bars. Optimal pain management remains a challenge. Mutimodal anesthesia alleviates pain through blockade of multiple nociceptive and inflammatory pain receptors.

Methods

A retrospective chart review of anesthetic and postoperative mangement of 125 children undergoing the Nuss procedure was conducted. Anesthetic mangement strategies were analyzed in four groups: opioid during general anesthesia (GA), epidural with general anesthesia (Epidural), multimodal anesthesia (MM), and multimodal anesthesia with methadone (MM + M). Data collection included total opioid use (as equivalent milligrams of morphine (Mmg)), pain scores, length of stay (LOS), and adverse effects.

Results

Total opioid use varied by group (median, IQR (in Mg)): Epidural 213 [149, 293], GA 179 [134, 298], MM (150 [123, 281]), and MM + M (106 [87, 149]), as did severe pain (in minutes): Epidural (208 [73, 323]), GA (115 [7, 255]), MM (54 [0, 210]), and MM + M (49 [0, 151]). LOS was shortest for the MM + M group (MM + M = 3.8 + 1.0 days; MM = 4.5 + 1.3 days; GA = 4.9 + 1.4 days, Epidural = 5.5 + 2.3 days).

Conclusion

Multimodal anesthesia is associated with less postoperative pain and shorter LOS compared to epidural or traditional anesthetic techniques for the Nuss procedure. Multimodal anesthesia with a single intraoperative dose of methadone was associated with lowest total opioid use, time with uncontrolled pain, and shortest LOS.