Systemic postoperative pain management following minimally invasive pectus excavatum repair in children and adolescents: a retrospective comparison of intravenous patient-controlled analgesia and continuous infusion with morphine

Abstract

Purpose: Optimal postoperative pain management following minimally invasive surgical repair of pectus excavatum is not established. We compared efficacy and adverse effects in patients treated with patient-controlled analgesia (PCA) with those treated with continuous infusion (CI) with morphine in addition to nonsteroidal anti-inflammatory drugs.

Methods: 33 patient records were examined retrospectively: 21 given PCA and 12 CI with morphine. Main outcome variables were used doses of morphine, pain scores every 3 h and adverse effects.

Results: Median (range) used morphine dose was 0.58 (0.21-1.12) and 0.52 (0.34-0.84) mg/kg on the day 1 and 0.3 (0.02-0.6) and 0.33 (0.09-0.53) mg/kg on the day 2 in PCA and CI groups, respectively (p > 0.05). Pain scores were within moderate and low levels during 42 h after surgery and did not differ between the groups. Median (range) oxygen saturation was 96.5 (93-100) and 97 (94-100) in PCA and CI groups, respectively (p > 0.05). Additional oxygen therapy was required in 14.3% in PCA group and 25% in CI group (p > 0.05). The incidence of pulmonary adverse effects was rare and did not differ between the groups.

Conclusion: Both methods of systemic analgesia in addition to non-opioid analgesics were equally effective and resulted in a low incidence of pulmonary adverse effects.