Age-related change of postoperative pain location after Nuss procedure for pectus excavatum

Objective: The present study aims to evaluate age-related change of postoperative pain after the Huss procedure by referring to clinical cases, and to elucidate the biomechanical aetiology of the change by using the finite element method. Methods: Twelve paediatric patients (paediatric group: 9.4 +/- 2.3 years old) and 13 adult patients (adult group: 26.3 +/- 5.5 years old) who received the Nuss procedure for pectus excavatum were included in the study. On the second postoperative day, the patients were asked to indicate regions on the thorax where they felt the greatest pain. The locations of these regions were compared between the two groups. In addition, stress-distribution patterns were examined using finite element models produced by simulating the thoraces of the patients. The stress-distribution patterns were compared between the two groups. Results: The patients of the paediatric group and adult group tend to have pain on the anterior and posterior regions of the thorax, respectively. The finite element study revealed that paediatric thoraces and adult thoraces develop intensified stresses in the anterior region and the posterior region, respectively. Conclusion: Postoperative pain tends to occur in the anterior part of the thorax for paediatric patients and in the posterior part of the thorax for adult patients, reflecting the stress distributions of these two distinct patient populations. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.