• Marc G Schlatter, Long V Nguyen, Maria Tecos, Elle L Kalbfell, Omar Gonzalez-Vega, and Tedi Vlahu.
• Helen DeVos Children's Hospital/Spectrum Health/Michigan State University Department of Surgery, Grand Rapids, Michigan. Electronic address: marc.schlatter@helendevoschildrens.org.
• J. Pediatr. Surg. 2019 Apr 1; 54 (4): 663-669.

PurposeManagement of postoperative pain is a significant challenge following the Nuss procedure. Epidurals, PCAs, and newer analgesia modalities have been used elsewhere without demonstrating consistent improvement in the reported length of hospital stays (LOS). We reviewed a large single surgeon experience identifying three different methods of analgesia used over time to highlight marked improvement in patient LOS.MethodsIRB approval was obtained and patient clinical information was retrospectively reviewed from 2001 to 2017. The primary outcome variable was length of hospital stay. An expanded preoperative consultation reviews the issue of pain, the negative impact of anxiety on recovery, and our current success of shortened hospital stays with our patients.ResultsOne hundred and seventy-three patients representing three different analgesia approaches had a LOS of 4.4 days (epidural); 2.2 days (PCA/intercostal nerve block); and 1.6 days (scheduled oral pain meds/intercostal nerve blocks). The current LOS for patients is 1.0 day. Patients successfully stop using narcotics by the end of the first week postoperatively.ConclusionsIntraoperative intercostal nerve blocks, scheduled postoperative pain medications, and enhanced preoperative consultation aimed to educate patients about anxiety and reframe patient pain expectations have collectively decreased LOS, and reduced postoperative narcotic usage.Type Of StudyClinical research LEVEL OF EVIDENCE: Level III.Copyright © 2019 Elsevier Inc. All rights reserved.

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