{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T22:44:56Z","timestamp":1773269096397,"version":"3.50.1"},"reference-count":21,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2016,4,7]],"date-time":"2016-04-07T00:00:00Z","timestamp":1459987200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Pain following Nuss procedure is severe and its management is challenging. Many different pain treatment modalities are currently being used, but none of them have been found to be ideal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>In this retrospective review, we compare our current multimodal approach, which involves continuous ropivacaine infusion through chest wall catheters (<jats:styled-content style=\"fixed-case\">CWC<\/jats:styled-content>), intravenous patient\u2010controlled analgesia (<jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">PCA<\/jats:styled-content>), and adjunctive medications (gabapentin and clonidine), with the technique that we used in the past, the thoracic epidural catheter (<jats:styled-content style=\"fixed-case\">TEC<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Following <jats:styled-content style=\"fixed-case\">IRB<\/jats:styled-content> approval, we performed a retrospective analysis of data on 32 patients who underwent the Nuss procedure at our institution. All children were divided into two groups: <jats:italic><jats:styled-content style=\"fixed-case\">TEC<\/jats:styled-content> group<\/jats:italic>: 0.2% ropivacaine and hydromorphone 10 mcg\u00b7ml<jats:sup>\u22121<\/jats:sup> epidural infusion (<jats:italic>n<\/jats:italic> = 15) and <jats:italic><jats:styled-content style=\"fixed-case\">CWC<\/jats:styled-content> group (with <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">PCA<\/jats:styled-content> and adjuncts [gabapentin + clonidine]):<\/jats:italic> 0.2% ropivacaine infusion and hydromorphone <jats:styled-content style=\"fixed-case\">PCA<\/jats:styled-content>, oral gabapentin, and transdermal clonidine patch (<jats:italic>n<\/jats:italic> = 17).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Both the groups were demographically similar. Average numeric pain scores were higher in the <jats:styled-content style=\"fixed-case\">CWC<\/jats:styled-content> group only on the day of surgery (mean \u00b1 <jats:sc>sd<\/jats:sc>: 3.79 \u00b1 1.58 vs 2.68 \u00b1 1.30; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: \u22122.16 to \u22120.05). Pain scores on postoperative day 1 (mean \u00b1 <jats:sc>sd<\/jats:sc>: 3.40 \u00b1 1.59 vs 3.35 \u00b1 1.32; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: \u22121.11 to 1.01), day 2 (mean\u00b1 <jats:sc>sd<\/jats:sc>: 3.39 \u00b1 1.79 vs 2.99 \u00b1 1.06; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: \u22121.50 to 0.70), and on the day of discharge (DOD) (mean\u00b1 <jats:sc>sd<\/jats:sc>: 3.25 \u00b1 1.84 vs 3.99 \u00b1 1.28; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: \u22120.42 to 1.89) were comparable between the groups. The <jats:styled-content style=\"fixed-case\">CWC<\/jats:styled-content> group needed fewer changes in the therapeutic regimen to maintain acceptable pain relief, had lower incidence of nausea and vomiting, had shorter anesthesia time, total <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> time, and hospital length of stay.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">TEC<\/jats:styled-content> provided better analgesia following the Nuss procedure only on the day of surgery. On the subsequent days until discharge, pain scores were comparable. However, <jats:styled-content style=\"fixed-case\">CWC<\/jats:styled-content> offered other advantages: it was less labor intensive and had fewer side effects, shorter <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> time, and shorter hospital stay.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.12904","type":"journal-article","created":{"date-parts":[[2016,4,10]],"date-time":"2016-04-10T17:42:19Z","timestamp":1460310139000},"page":"582-589","source":"Crossref","is-referenced-by-count":34,"title":["Continuous chest wall ropivacaine infusion for analgesia in children undergoing Nuss procedure: a comparison with thoracic epidural"],"prefix":"10.1111","volume":"26","author":[{"given":"Dinesh K.","family":"Choudhry","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Nemours\/Alfred I. duPont Hospital for Children Wilmington DE USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B. Randall","family":"Brenn","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Nemours\/Alfred I. duPont Hospital for Children Wilmington DE USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"Sacks","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Nemours\/Alfred I. duPont Hospital for Children Wilmington DE USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirk","family":"Reichard","sequence":"additional","affiliation":[{"name":"Department of Surgery Nemours\/Alfred I. duPont Hospital for Children Wilmington DE USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,4,7]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3468(98)90314-1"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-194904000-00002"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/1749-8090-9-25"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2010.01.028"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3468(96)90329-2"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2014.02.072"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12369"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1744-1633.12017"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2007.09.024"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeq006"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03009262"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199709000-00005"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2008.02590.x"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ANE.0000177099.28914.A7"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181d41dc2"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e318249d36e"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2006.06.018"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199110000-00006"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-198903000-00002"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-199412000-00015"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(94)00121-T"}],"container-title":["Pediatric Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fpan.12904","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pan.12904","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T11:23:05Z","timestamp":1696245785000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pan.12904"}},"subtitle":[],"editor":[{"given":"Per\u2010Arne","family":"Lonnqvist","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2016,4,7]]},"references-count":21,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2016,6]]}},"alternative-id":["10.1111\/pan.12904"],"URL":"https:\/\/doi.org\/10.1111\/pan.12904","archive":["Portico"],"relation":{},"ISSN":["1155-5645","1460-9592"],"issn-type":[{"value":"1155-5645","type":"print"},{"value":"1460-9592","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,4,7]]}}}