Title

Long-term patient perception of pain control experience after participating in a trial between patient-controlled analgesia and epidural after pectus excavatum repair with bar placement.

Document Type

Article

Publication Date

11-1-2013

Identifier

DOI: 10.1016/j.jss.2013.03.093

Abstract

BACKGROUND: Pain control is the dominant management issue after bar placement for pectus excavatum. We previously conducted a prospective, randomized trial comparing patient-controlled analgesia (PCA) to thoracic epidural (EPI) documenting similar objective outcomes. Our impression is that the subjective cognitive experience differs between the groups, which impacts trial results interpretation. Therefore, we conducted a survey to ascertain patient recollection and impression of their experience.

METHODS: By telephone questionnaire, yes/no questions included early course recall, anxiety, if they would choose the same arm, do the operation again, or recommend it to friends. Qualitative questions included description, location, and time of peak pain. The graded question addressed severity of pain (1-5).

RESULTS: We contacted 27 EPI and 38 PCA patients with a median follow-up of 3.2 y. The majority (~/= 85%) of both groups remembered the first 2 d. Mean pain severity was 3.0 in both groups (3 = bad, but tolerable). Description, location, and time of peak pain responses did not differ. Anxiety was reported by 30% of EPI group and 18% of PCA group (P = 0.37). Approximately 15% of both groups still think about the pain. No differences were seen in nausea, emesis, constipation, itching, or sleepiness. Most patients would choose the same group (87% PCA, 81% EPI, P = 0.73), have the operation again (87% PCA, 74% EPI, P = 0.21), and recommend the operation to friends (100% PCA, 96% EPI, P = 0.42).

CONCLUSIONS: Long-term recall after repair of pectus excavatum with bar placement does not substantially differ between those managed with an epidural or PCA.

Journal Title

The Journal of surgical research

Volume

185

Issue

1

First Page

12

Last Page

14

MeSH Keywords

Analgesia, Epidural; Analgesia, Patient-Controlled; Analgesics, Opioid; Follow-Up Studies; Funnel Chest; Interviews as Topic; Orthopedic Procedures; Oxycodone; Pain Threshold; Pain, Postoperative; Patient Satisfaction; Prospective Studies; Time

Keywords

Epidural; PCA; Pain control; Pectus bar; Pediatric

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