• Steve Coppens, Geertrui Dewinter, Danny Feike Hoogma, Marc Raudsepp, Randy Vogelaerts, Liesbeth Brullot, Arne Neyrinck, Hans Van Veer, Rebekka Dreelinck, and Steffen Rex.
• From the Department of Anesthesiology, University Hospitals of Leuven (SC, GD, DFH, MR, RV, LB, AN, RD, SR), Department of Cardiovascular Sciences, Biomedical Sciences Group, University of Leuven (SC, GD, DFH, AN, HvV, SR) and Department of Thoracic Surgery, University Hospitals of Leuven, Leuven, Belgium (HvV).
• Eur J Anaesthesiol. 2024 Dec 1; 41 (12): 873880873-880.

BackgroundChest wall surgery for the correction of pectus excavatum or pectus carinatum has gained increased interest in recent years. Adequate pain treatment, respiratory physiotherapy and early ambulation are key to improving the outcomes. Although thoracic epidural analgesia is highly effective, its safety is controversial, leading to extensive scrutiny and questioning of its role.ObjectivesWe hypothesise that thoracic epidural analgesia is effective and well tolerated to use in adolescents, with a high success rate and low pain scores.DesignObservational retrospective cohort study.SettingAll adolescent cases in a high-volume academic tertiary chest wall surgery centre between March 1993 and December 2017 were included.PatientsA total of 1117 patients aged from 12 to 19 years of age and receiving either Ravvitch, Nuss or Abramson chest wall reconstruction for pectus excavatum were identified in our institutional chest wall surgery database. After applying selection and exclusion criteria, 532 patients were included in the current analysis.Main Outcome MeasuresThe primary endpoint of this study was the safety of epidural analgesia, assessed by the incidence of acute adverse events. Secondary endpoints were block success rates using a specific novel definition, and analgesic efficacy using recorded postoperative pain scores.ResultsMore than 60% of patients experienced one or more adverse events. However, all events were minor and without consequences. No serious or long-term adverse events were detected. The success rate of thoracic epidural placement was 81%. Low postoperative pain scores were observed.ConclusionThoracic epidural analgesia is an extremely effective pain control technique, with a surprisingly high number of minor adverse events but safe with regard to serious adverse events.Trial RegistrationThe local research ethics committee approved and registered this study on 16 May 2022 (registration number: S66594).Copyright © 2024 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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