• Tomohisa Nagasao, Junpei Miyamoto, Kazuhiko Ichihara, Hua Jiang, Hongmei Jin, and Tamotsu Tamaki.
• Department of Plastic and Reconstructive Surgery, School of Medicine, Keio University, Tokyo, Japan. nagasao@sc.itc.keio.ac.jp
• Eur J Cardiothorac Surg. 2010 Aug 1; 38 (2): 203-8.

ObjectiveThe present study aims to evaluate age-related change of postoperative pain after the Nuss procedure by referring to clinical cases, and to elucidate the biomechanical aetiology of the change by using the finite element method.MethodsTwelve 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.ResultsThe 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.ConclusionPostoperative 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.Copyright 2010. Published by Elsevier B.V.

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