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

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.