Postoperative opioid analgesic use after Nuss versus Ravitch pectus excavatum repair

J Pediatr Surg. 2014 Jun;49(6):919-23; discussion 923. doi: 10.1016/j.jpedsurg.2014.01.025.


Background/purpose: Anticipated postoperative pain may affect procedure choice in patients with pectus excavatum. This study aims to compare postoperative pain in patients undergoing Nuss and Ravitch procedures.

Methods: A 5year retrospective review was performed. Data on age, gender, Haller index, procedure, pain scores, pain medications, and length of hospital stay were collected. Total inpatient opioid administration was converted to morphine equivalent daily dose per kilogram (MEDD/kg) and compared between procedures.

Results: One hundred eighty-one patients underwent 125 (69%) Nuss and 56 (31%) Ravitch procedures. Ravitch patients were older (15.7 yo vs 14.6 yo, p=0.004) and had a higher Haller index (5.21 vs 4.10, p=<0.001). Nuss patients had higher average daily pain scores, received 25% more opioids (MEDD/kg 0.66 vs. 0.49, p=<0.001), and received twice as much IV diazepam/kg. In the multivariate analysis, higher MEDD/kg correlated with both the Nuss procedure and older age in the Nuss group. Opioid administration did not correlate with Haller index or Nuss bar fixation technique. Increased NSAID administration did not correlate with lower use of opioids.

Conclusion: The Nuss procedure is associated with greater postoperative pain compared to the Ravitch procedure. Opioid use is higher in older patients undergoing the Nuss procedure, but is not associated with severity of deformity.

Keywords: Morphine equivalent daily dose; Nuss procedure; Opioid; Pain; Pectus excavatum; Ravitch procedure.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Analgesics, Opioid / administration & dosage*
  • Child
  • Dose-Response Relationship, Drug
  • Female
  • Follow-Up Studies
  • Funnel Chest / surgery*
  • Humans
  • Injections, Intravenous
  • Length of Stay / trends
  • Male
  • Morphine / administration & dosage*
  • Pain Measurement
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / drug therapy*
  • Retrospective Studies
  • Thoracoplasty / methods*
  • Time Factors
  • Treatment Outcome
  • Young Adult


  • Analgesics, Opioid
  • Morphine