Postoperative Pain Management After Minimally Invasive Repair of Pectus Excavatum: A Systematic Review and Network Meta-analysis

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2025-03-21 DOI:10.1016/j.jpedsurg.2025.162282

Elise J. Van Polen, Chiel J. Franssen, Jean H.T. Daemen, Austin J. Isabella, Aimée J.P.M. Franssen, Karel W.E. Hulsewé, Yvonne L.J. Vissers, Erik R. de Loos

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引用次数: 0

Abstract

Background

Minimally invasive repair of pectus excavatum is the accepted standard approach for correction of pectus excavatum. This procedure is associated with significant postoperative pain, which is the dominant factor determining the duration of hospitalization. To date, a multitude of analgesic modalities are used, however, the most effective is to be corroborated. The aim of this study is to systematically evaluate and compare all available analgesic modalities for pain management after minimally invasive repair of pectus excavatum through a network meta-analysis.

Methods

Electronic scientific databases were systematically searched. Articles were eligible for inclusion when designed as a comparative study evaluating perioperative pain management techniques for patients undergoing minimally invasive repair of pectus excavatum and where length of hospitalization was reported as an outcome. Data concerning length of hospitalization were extracted and submitted for network meta-analysis.

Results

Thirty-nine studies were included, enrolling 4241 patients. Through a network meta-analysis intercostal nerve cryoablation with an adjunct analgesic intervention (e.g., intercostal nerve block or patient controlled analgesia) showed a statistically significant reduction in the length of hospitalization ranging from 0.9 days (95 % confidence interval (CI): −1.7 to −0.1) when compared to locoregional blocks with an adjunct analgesic intervention to 2.5 days (95 % CI: −3.7 to −1.3) when compared to thoracic epidural analgesia.

Conclusion

Regarding postoperative pain management after minimally invasive repair of pectus excavatum, intercostal nerve cryoablation with adjunct analgesic intervention is more effective in terms of length of hospitalization compared to other forms of analgesia.

Type of Study

Systemic review and meta analysis.

查看原文本刊更多论文

微创漏斗胸修复术后疼痛处理：系统回顾和网络荟萃分析。

背景：对漏斗胸进行微创修复是目前公认的矫正漏斗胸的标准方法。该手术与明显的术后疼痛相关，这是决定住院时间的主要因素。迄今为止，使用了多种镇痛方式，然而，最有效的是有待证实的。本研究的目的是通过网络meta分析系统地评估和比较所有可用的镇痛方式，用于微创漏斗胸修复后的疼痛管理。方法：系统检索电子科学数据库。当文章被设计为评估微创漏斗胸修复术患者围手术期疼痛管理技术的比较研究，并且住院时间作为结果报告时，文章才有资格被纳入。提取有关住院时间的数据并提交网络荟萃分析。结果：纳入39项研究，纳入4241例患者。通过网络荟萃分析，肋间神经冷冻消融联合辅助镇痛干预（例如，肋间神经阻滞或患者自控镇痛）显示，与局部区域阻滞联合辅助镇痛干预相比，住院时间减少了0.9天（95%置信区间（CI）： -1.7至-0.1），与胸椎硬膜外镇痛相比，住院时间减少了2.5天（95% CI: -3.7至-1.3），具有统计学意义。结论：对于漏斗胸微创修复术后疼痛的处理，肋间神经冷冻消融联合辅助镇痛干预比其他镇痛方式在住院时间上更有效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.