Best Evidence Summary for Perioperative Pain Management in Patients With Pectus Excavatum.

Abstract

Background: Pectus excavatum is a common congenital chest wall deformity that can lead to significant cardiopulmonary compression and psychological distress. The minimally invasive Nuss procedure is the standard treatment, but it often results in severe postoperative pain. Effective perioperative pain management is essential to enhance recovery and improve patient outcomes. Objectives: This study aimed to synthesize the most effective evidence on perioperative pain management in patients with pectus excavatum and to provide evidence-based management methods for clinical teams and patients undergoing this surgery. Methods: Guided by the "6S" pyramid model, we retrieved evidence on perioperative pain management from relevant websites, databases, and unpublished gray literature. The search timeframe ranged from 2014 to December 2024. Two researchers independently evaluated the literature quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) for guidelines and the Joanna Briggs Institute (JBI) critical appraisal tool for other types of literature. Two researchers independently extracted and summarized the evidence according to the principle of high-quality evidence and newly published evidence. Results: A total of 39 articles were retrieved, of which 6 were guidelines, 6 were expert consensus, 7 were systematic reviews, 1 was a clinical decision, 11 were randomized controlled trials, and 8 were cohort studies. Overall, 35 pieces of evidence from seven dimensions-general principles, education and counseling, pain assessment, preemptive analgesia, intraoperative analgesia, postoperative pain management, and pain management after discharge-were summarized. Conclusions: This study summarized the best evidence on perioperative pain management in patients with pectus excavatum, providing a comprehensive and scientific approach to enhance recovery and patient satisfaction.