What is the postoperative care following minimally invasive repair of pectus excavatum (MIRPE)?

Updated: Oct 30, 2018
  • Author: Andre Hebra, MD; Chief Editor: Girish D Sharma, MD, FCCP, FAAP  more...
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Answer

Pain management typically requires keeping the patient well sedated for the first 1-3 days to prevent bar displacement. Medications and therapies depend on the patient's response to pain and may include an epidural catheter, intravenous narcotics for breakthrough pain, patient-controlled analgesia (PCA), and nonsteroidal anti-inflammatory drugs (NSAIDs). In the first postoperative day, the patient is kept flat, with a straight thoracic spine, and is allowed only a small pillow. Mobilization is permitted on the second postoperative day by flexing the bed at the hip level and keeping the back straight. Do not permit waist bending, twisting, and log rolling. Avoid allowing the patient to sit in bed with the thoracic spine flexed. The patient needs assistance when getting out of bed the first few times.

The epidural catheter is generally removed on the third postoperative day, and the patient should be fully ambulatory after that point. The patient is discharged home when able to walk unassisted. The average length of stay is 4-7 days. Good posture with a straight back is very important, even after discharge. Again, bending at the hip and slouching are not allowed in the first month. Regular activity is permitted as pain reduces and mobility increases. Heavy lifting is not permitted for one month following surgery, and contact sports are to be avoided for at least 3 months. The bar generally remains implanted for 2 years and is removed in an outpatient procedure under anesthesia.


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