Post Operative Pain Control Using Ropivacaine and the ON-Q System in the Adult Pectus Excavatum Patient After Minimally Invasive Repair

Pectus excavatum (PE) is a common chest wall deformity where the sternum is displaced
posteriorly. In severe cases, surgery is performed to correct the defect (1). In recent
years, minimally invasive surgery with the placement of stainless steel support bars has
been increasingly performed in patients over the age of 17 years (1-9). Because of the
decreased malleability and tremendous pressure required to hold the chest wall in the
corrected position, post-operative pain control has been a significant problem in this
patient population (2,6,9-12). Thoracic epidurals are commonly employed however mean
hospitalizations of up to 7 days have been required before adequate pain control on oral
analgesics is obtained (3-5, 13) and patients are suitable for discharge.

It is hypothesized that using the ONQ system (I-Flow Corporation, Lake Forest CA) with
bilateral intercostal catheter infusion would provide adequate post operative pain control
with a significantly shorter hospital length-of-stay than thoracic epidural. Total use of
narcotics for 1 week following surgery would also be less with the ONQ system versus
epidural.