Pain management using patient controlled anaesthesia in adults post Nuss procedure: an analysis with respect to patient satisfaction

Shyamsunder Kolvekar, Hans Pilegaard, Elizabeth Ashley, Natalie Simon, Joseph Grant


Background: The Nuss procedure for correction of pectus excavatum is commonly associated with severe postoperative pain. The belief that thoracic epidural offers the best pain control has recently come under scrutiny after several studies have shown patient controlled anaesthesia (PCA) to be just as effective. Nevertheless, centres who have shifted to an exclusively PCA regime exist in the minority. We have conducted a retrospective survey of all patients who underwent the Nuss procedure at the Heart Hospital, London, where all patients are managed exclusively using PCA. The study aims to assess the efficacy and validity of our practice.
Methods: A retrospective survey was carried out on 149 patients (139 males and 10 females), with an average age of 28, after undergoing a Nuss bar insertion. The study was conducted between August and October, 2014. The PCA technique used a 1 mg bolus dose of morphine sulphate, administered through a 5-minute lockout. There was no background infusion and no maximum dose limit in a 4-hour period. The outcome of the study measured patient satisfaction with postoperative analgesia and medication prescribed for home usage. The pre-operative provision of information with regard to patient expectations of pain was also assessed. The study is approved by the institutional ethical committee and has obtained the informed consent from every patient.
Results: The majority of patients were either satisfied or extremely satisfied with the pain management received in hospital immediately following surgery. Additionally, a substantial number of patients strongly agreed that they were adequately warned about postoperative pain prior to the operation. None of the cohort specified that they experienced more pain than expected or thought that the medication prescribed for home usage was inadequate. Moreover, a small minority of patients reported postoperative long-term or chronic pain, with only one reporting that it lasted for longer than 6 months.
Conclusions: Results obtained from retrospective patient satisfaction surveys indicate high efficacy for PCA as a pain management strategy. The large majority of patients did not seek more medication for pain alleviation and found in-hospital treatment sufficient. Further, all patients agreed that they were adequately informed of pain-risk prior to surgery.