Update Course Rewind: Pectus Excavatum 2021
With Dr. Steven Lee & Dr. Sean Saint Peter & Dr. Victor Garcia & Dr. Steven Rothenberg · hosted by Dr. Cecilia Gena & Dr. Ellen Ancisco · StayCurrentMD
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Podcast
Update Course Rewind: Pectus Excavatum 2021
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Podcast
Update Course Rewind: Pectus Excavatum 2021
Dr. Lee Ponsky · 11 min · Published Aug 2022
Podcast
Update Course Rewind: Pectus Excavatum 2021
Dr. Lee Ponsky · 11 min · Published Aug 2022
Podcast
Update Course Rewind: Pectus Excavatum 2021
Dr. Lee Ponsky · 11 min · Published Aug 2022
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What the experts said
A randomized trial of 110 patients comparing epidural and PCA for pectus excavatum pain control showed epidurals did not provide superior pain relief
After implementing cryoanalgesia, patients went home on post-operative day one
Cryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain
Cryoanalgesia technique involves freezing ribs 4 through 7 for 2 minutes per rib
Cryoanalgesia should not be performed on rib 8 or below because it can cause abdominal wall paralysis
With cryoanalgesia, length of stay decreased from 4 days to 1 day
Median morphine equivalents with cryoanalgesia are dramatically lower than with previous pain control methods
There are no long-term studies on cryoanalgesia outcomes
Medical devices and implants are not required to undergo clinical trials before market introduction, unlike drugs
Erector spinal catheters are placed by the pain team with ultrasound guidance and are juxtaposed to but not in the vertebral space
With erector spinal catheters, hospital stay is 2 days, catheters stay in for 5 days total and are removed by family on day 3 at home
Erector spinal catheters reduce opioid requirements both in hospital and after discharge
With cryoanalgesia, patients feel significantly better when discharged compared to other pain control methods
Multimodal pain therapy components include preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and anti-emetics
With multimodal pain regimen at Nebraska, length of stay is under 2 days and patients are off opioids by 1 week
Bar flippage typically occurs early and is due to the bar sitting in an incorrect interspace, not being wrapped tightly enough, or not being secured well
Bar flippage is completely a surgical technique issue
Computational modeling shows shorter flat bars have more pressure on the sternum and are therefore more stable than traditional U-shaped bars
Sternal elevator is used in about 10% of cases, primarily in really deep stiff pectuses to allow less tissue damage
Using sternal elevator allows passage in and out at the same interspace without guesswork
Multiple safety techniques (thoracoscopy, sternal elevator, vacuum bell, subxiphoid incision) can be used to avoid cardiac injury during bar passage
Passing the bar from left chest to right chest means the introducer is not pointing directly at the ventricle
Direction of bar passage (left-to-right versus right-to-left) is surgeon preference as long as substernal space is well dissected and visualization is clear