Format

Send to

Choose Destination
J Pediatr Surg. 2016 Apr;51(4):612-6. doi: 10.1016/j.jpedsurg.2015.10.084. Epub 2015 Nov 6.

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.

Author information

1
Valley Anesthesiology Consultants, Phoenix Children's Hospital, Surgery and Pain Management, Phoenix, AZ, USA. Electronic address: rsinghal@valley.md.
2
Valley Anesthesiology Consultants, Phoenix Children's Hospital, Surgery and Pain Management, Phoenix, AZ, USA.

Abstract

BACKGROUND:

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+1.0days; MM=4.5+1.3days; GA=4.9+1.4days, Epidural=5.5+2.3days).

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.

KEYWORDS:

Methadone; Multimodal anesthesia; Nuss procedure; Pain management; Pectus excavatum

PMID:
26700690
DOI:
10.1016/j.jpedsurg.2015.10.084
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center