Aim: Surgical repair of chest wall deformities, using the Nuss or modified-Ravitch technique can be associated with significant post-operative pain. Thoracic epidurals have previously been the mainstay of perioperative analgesia in our centre, however these are invasive procedures and can be associated with significant complications. Continuous peripheral nerve blockage using local anaesthetics via wound infusion catheters (WICs) can be an effective alternative. However, recent reports have suggested that surgical site infection (SSI) rates of up to 30% may be seen when used alongside chest wall surgery.
The aim of this retrospective study was to determine whether the change from epidural analgesia to WICs has been associated with any increase in SSIs following chest wall surgery.
Methods: All patients undergoing a modified-Ravitch procedure from April 2014 to October 2017 were identified. Demographic, operative, anaesthetic and complication data were collected. The primary outcome measures were documented SSI and removal of metal support bars. Data are presented as median (interquartile range) unless specified otherwise. Fishers’ exact test was used for categorical data and Mann-U Whitney for non-parametric continuous data, significance was set at p=0.05.
Results: 24 modified-Ravitch procedures were performed for both pectus carinatum (11/24) and excavatum (13/24) deformities, at a median age of 15.8 (15.4-17) years. Metal support-bars were placed in 13 patients (8 with WICs). 12 patients received epidural analgesia and 12 had WICs. Median follow-up was 5.8 (3.9-8.9) months. There was no significant difference in length of stay (p=0.6) or duration to switch to oral analgesia (p=0.3) between the two groups. Two SSIs were recorded in the study period, one superficial wound infection and empyema, both in the epidural group. No metal implants required removal for infection.
Conclusion: In our series, WICs are a safe and efficacious alternative to thoracic epidurals following chest wall surgery with or without metal implants.