{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T20:51:20Z","timestamp":1769633480069,"version":"3.49.0"},"reference-count":28,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Minimally invasive repair of pectus excavatum (MIRPE) is an established surgical treatment for adult pectus excavatum (PE). Compared with pediatric patients, adults generally have a more rigid chest wall and greater costal cartilage ossification, often resulting in more severe postoperative pain. However, most previous studies have focused on pediatric patients with PE and on evaluating effective analgesic methods. This study aimed to investigate perioperative factors associated with postoperative opioid requirements and pain intensity in adult patients undergoing MIRPE. Methods: This study was a single-center retrospective study of adult PE patients who underwent MIRPE between March 2011 and January 2023. The primary outcome was total opioid consumption during the first 24 postoperative hours. Secondary outcomes included opioid and rescue analgesic use within 0\u20136, 6\u201324, and 24\u201348 h, as well as pain intensity during each interval. Multivariable linear regression analysis was performed to identify factors associated with postoperative opioid consumption. Results: A total of 382 patients were analyzed. Pain intensity peaked within the first 6 postoperative hours, decreased during the 6\u201324 h and increased during 24\u201348 h period. Higher BMI and placement of more than three bars were independently associated with greater opioid consumption during the first 6 h (p &lt; 0.001). Within 24 and 48 h, male sex, longer operation time and higher BMI were independently associated with opioid consumption (p &lt; 0.001). During 6\u201324 and 24\u201348 h period, VAS severity was significantly higher in male patients and those with longer operation times. Conclusions: Male sex, higher BMI, prolonged operation time, and multiple bar insertion may contribute to greater postoperative opioid requirements during the early postoperative phase in adult patients undergoing MIRPE.<\/jats:p>","DOI":"10.3390\/jcm15031023","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T15:41:56Z","timestamp":1769528516000},"page":"1023","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Analysis of Factors Affecting Postoperative Opioid Requirement in Adult Patients Undergoing Minimally Invasive Repair of Pectus Excavatum"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2864-790X","authenticated-orcid":false,"given":"Minju","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6930-3771","authenticated-orcid":false,"given":"Saewon","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2609-2148","authenticated-orcid":false,"given":"Seung Keun","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2820-0322","authenticated-orcid":false,"given":"Wonjung","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Biavati, M., Kozlitina, J., Alder, A.C., Foglia, R., McColl, R.W., Peshock, R.M., Kelly, R.E., and Kim Garcia, C. (2020). Prevalence of pectus excavatum in an adult population-based cohort estimated from radiographic indices of chest wall shape. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0232575"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Viggiano, D., Bongiolatti, S., Borgianni, S., Lo Piccolo, R., Voltolini, L., and Gonfiotti, A. (2022). Nuss Technique for Pectus Excavatum in Adult Patients: Cosmetic Satisfaction and Improvement of Quality of Life in a Single-Center Experience. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.903791"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"577","DOI":"10.5604\/15093492.1193010","article-title":"Comparison of Postoperative Period in Patients with Pectus Excavatum Treated with Nuss Technique and Ravitch Technique","volume":"17","author":"Potaczek","year":"2015","journal-title":"Ortop. Traumatol. Rehabil."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.jss.2024.09.025","article-title":"Outcomes After Pectus Excavatum Repair: A Nationwide Comparison of Nuss Versus Ravitch Operations","volume":"303","author":"Huerta","year":"2024","journal-title":"J. Surg. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1016\/j.athoracsur.2020.10.017","article-title":"Nuss Procedure for Pectus Excavatum: A Comparison of Complications Between Young and Adult Patients","volume":"112","author":"Pennings","year":"2021","journal-title":"Ann. Thorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1016\/j.ejcts.2009.09.035","article-title":"Postoperative consumption of opioid analgesics following correction of pectus excavatum is influenced by pectus severity: A single-centre study of 236 patients undergoing minimally invasive correction of pectus excavatum","volume":"37","author":"Grosen","year":"2010","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.athoracsur.2018.07.086","article-title":"Standardized Haller and Asymmetry Index Combined for a More Accurate Assessment of Pectus Excavatum","volume":"107","author":"Sesia","year":"2019","journal-title":"Ann. Thorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1016\/j.jpedsurg.2014.11.043","article-title":"The Depression Index: An objective measure of the severity of pectus excavatum based on vertebral diameter, a morphometric correlate to patient size","volume":"50","author":"Fagelman","year":"2015","journal-title":"J. Pediatr. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2587","DOI":"10.2147\/JPR.S170269","article-title":"Practical management of opioid rotation and equianalgesia","volume":"11","author":"Treillet","year":"2018","journal-title":"J. Pain. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1016\/j.athoracsur.2021.08.060","article-title":"Sex Differences in Objective Measures of Adult Patients Presenting for Pectus Excavatum Repair","volume":"114","author":"Ravanbakhsh","year":"2022","journal-title":"Ann. Thorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.atssr.2024.04.013","article-title":"Complication Rate of the Nuss Procedure in Adults and Pediatric Patients: National Database Analysis","volume":"2","author":"Rshaidat","year":"2024","journal-title":"Ann. Thorac. Surg. Short. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"267","DOI":"10.3344\/kjp.2012.25.4.267","article-title":"Pain and anxiety management in minimally invasive repair of pectus excavatum","volume":"25","author":"Ghionzoli","year":"2012","journal-title":"Korean J. Pain."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Koo, J.M., Park, H.J., Rim, G.M., Hyun, K., Huh, J., Choi, H., Kim, Y., and Hwang, W. (2023). Analysis of Factors Affecting Postoperative Opioid Requirement in Pediatric Patients Undergoing Pectus Excavatum Repair with Multimodal Analgesic Management. J. Clin. Med., 12.","DOI":"10.3390\/jcm12165240"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"ziae153","DOI":"10.1093\/jbmrpl\/ziae153","article-title":"Bending properties of human cartilaginous ribs and costal cartilage material vary with age, sex, and calcification","volume":"9","author":"Goh","year":"2025","journal-title":"JBMR Plus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"111242","DOI":"10.1016\/j.jbiomech.2022.111242","article-title":"Measurement of global mechanical properties of human thorax: Costal cartilage","volume":"142","author":"Gradischar","year":"2022","journal-title":"J. Biomech."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1007\/s00383-020-04738-5","article-title":"The chest wall gender divide: Females have better cardiopulmonary function and exercise tolerance despite worse deformity in pectus excavatum","volume":"36","author":"Jenkins","year":"2020","journal-title":"Pediatr. Surg. Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1183\/20734735.000318","article-title":"Sex differences in respiratory function","volume":"14","author":"LoMauro","year":"2018","journal-title":"Breathe"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.jtcvs.2009.12.027","article-title":"Double-bar application decreases postoperative pain after the Nuss procedure","volume":"140","author":"Nagaso","year":"2010","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_19","first-page":"ivae168","article-title":"Clinical impact of multiple pectus bars on surgical outcomes following pectus excavatum repair","volume":"39","author":"Oka","year":"2024","journal-title":"Interdiscip. Cardiovasc. Thorac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Lo, P.C., Tzeng, I.S., Hsieh, M.S., Yang, M.C., Wei, B.C., and Cheng, Y.L. (2020). The Nuss procedure for pectus excavatum: An effective and safe approach using bilateral thoracoscopy and a selective approach to use multiple bars in 296 adolescent and adult patients. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0233547"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1080\/10255842.2012.671307","article-title":"The effect of calcification on the structural mechanics of the costal cartilage","volume":"17","author":"Forman","year":"2014","journal-title":"Comput. Methods Biomech. Biomed. Eng."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.ejcts.2009.12.047","article-title":"Age-related change of postoperative pain location after Nuss procedure for pectus excavatum","volume":"38","author":"Nagasao","year":"2010","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_23","first-page":"62","article-title":"Scoring of Deformed Costal Cartilages Reduces Postoperative Pain after Nuss Procedure for Pectus Excavatum","volume":"64","author":"Nagasao","year":"2016","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_24","first-page":"152","article-title":"Pharmacokinetics in obese patients","volume":"4","author":"Mortier","year":"2004","journal-title":"Contin. Educ. Anaesth. Crit. Care Pain"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1097\/ALN.0b013e31828866b3","article-title":"Pain intensity on the first day after surgery: A prospective cohort study comparing 179 surgical procedures","volume":"118","author":"Gerbershagen","year":"2013","journal-title":"Anesthesiology"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Chen, L.-J., Chen, S.-H., Hsieh, Y.-L., and Yu, P.-C. (2023). Continuous nerve block versus thoracic epidural analgesia for post-operative pain of pectus excavatum repair: A systematic review and meta-analysis. BMC Anesthesiol., 23.","DOI":"10.1186\/s12871-023-02221-x"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1097\/AJP.0000000000001067","article-title":"Factors Associated With Rebound Pain After Patient-controlled Epidural Analgesia in Patients Undergoing Major Abdominal Surgery: A Retrospective Study","volume":"38","author":"Kwon","year":"2022","journal-title":"Clin. J. Pain"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1097\/ACO.0b013e32833b0a8c","article-title":"Perioperative pharmacology in morbid obesity","volume":"23","author":"Lemmens","year":"2010","journal-title":"Curr. Opin. Anaesthesiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/1023\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T09:07:01Z","timestamp":1769591221000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/1023"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,27]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15031023"],"URL":"https:\/\/doi.org\/10.3390\/jcm15031023","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,27]]}}}