Integrative Medicine Modalities for Adolescent Patients Undergoing Minimally Invasive Repair of Pectus Excavatum: A Scoping Review

Abstract

Background: The minimally invasive repair of pectus excavatum (MIRPE), a surgical procedure done primarily in adolescence to correct pectus excavatum (PE), a congenital chest wall deformity, is associated with significant postoperative pain and opioid consumption. The use of an integrative medicine (IM) approach-combining complementary therapies with conventional treatments-can support postoperative pain management and potentially reduce opioid consumption in adolescent patients undergoing this procedure. This scoping review examines the published literature addressing the use of IM modalities in adolescent patients undergoing MIRPE. Methods: A comprehensive search of MEDLINE, EMBASE, Web of Science Core Collection, and Google Scholar was conducted from inception through January 2024. Studies were included if they addressed the inclusion of at least one IM modality during the MIRPE perioperative to support pain management. These modalities could be delivered at any time during that period and used alongside any conventional analgesic methods. Results: Eleven studies met the inclusion criteria. Eight of these (72.7%) implemented an integrative modality in this population. Of these eight, the most common integrative modalities were mindfulness/purposeful relaxation (n = 5), self-hypnosis (n = 3), cognitive-behavioral therapy (CBT) (n = 2), music/music therapy (n = 2), aromatherapy (n = 1), and massage (n = 1). Only six studies described the use of an integrative modality as an experimental condition. Still, self-hypnosis (n = 3), CBT (n = 2), and virtual reality-guided relaxation (n = 1) all augment postoperative pain management. While these studies have low levels of evidence and/or small sample sizes, they still demonstrated reduced pain scores (n = 4) and opioid consumption (n = 2) without appreciable adverse effects. Conclusion: There is a paucity of literature examining the use of integrative modalities in adolescent patients undergoing MIRPE. The included studies demonstrate preliminary evidence of the positive outcomes associated with IM modalities overall and a low-risk profile. However, the small number of studies, observational and retrospective designs, limited sample sizes, and large heterogeneity across the studies demonstrate limited, low-level evidence, highlighting a need for further rigorous research to determine the efficacy of these modalities. Further investigation, especially in specific promising modalities such as hypnosis and guided relaxation, is warranted. Incorporating IM modalities into perioperative care for this population should be further explored.

Keywords: complementary therapies; hypnosis; integrative medicine; mindfulness; pectus excavatum; prehabilitation.