International variability in pain management for the minimally invasive repair of pectus excavatum: a survey by the Chest Wall International Group.

Background: The Nuss procedure for pectus excavatum correction is often accompanied by severe postoperative pain. Several analgesic techniques have been researched; however, a consensus on the optimal strategy has not been reached. This survey aims to quantify the international variability in perioperative pain management following the Nuss procedure. Methods: A cross-sectional survey was designed using Qualtrics XM and distributed via the Chest Wall International Group (CWIG), the world's largest medical association for chest wall deformities. Medical specialists directly involved in the treatment of pectus excavatum were included. Demographics and views on the use of various analgesic techniques were collected. Data analysis was performed using IBM SPSS (v27.0). The index of qualitative variation (IQV) was calculated to quantify variability in responses. Results: The analysis included 71 participants from across Europe (47%), North America (28%), South America (13%), Asia (9%), Australia (3%), and Africa (1%). Of these participants, 70% had >10 years of experience with the Nuss procedure. Participants using standardized pain management (n=64) showed a high global variance in primary analgesic technique (IQV 0.86). A continental sub-analysis solely showed a low variance in North America (IQV 0.14) with a preference towards intercostal nerve cryoablation (94%). Most participants used additional analgesic techniques (89%) in their standardized protocol. Conclusions: These findings revealed high international variability in pain management following the Nuss procedure. Nevertheless, results did suggest a global agreement on a multimodal approach. Future research should focus on providing high-quality evidence on the optimal technique to reduce variability in perioperative pain management.