Postoperative pain management in pediatric patients undergoing minimally invasive repair of pectus excavatum: The role of intercostal block

Comparison of Ultrasonography-guided Bilateral Intercostal Nerve Blocks and Conventional Patient-controlled Intravenous Analgesia for Pain Control After the Nuss Procedure in Children

“…Previous studies have examined the analgesic effects of conventional8–9,24–26 and ultrasound-guided27,28 ICNBs in patients undergoing percutaneous nephrolithotomy,24,27 open cholecystectomy,25 breast surgery,26,28 and the Nuss procedure 8,9. They demonstrated that ICNBs could decrease pain intensity and improve the health-related quality of life in the immediate postoperative period.…”

“…However, high-dose systemic opioids may increase the incidence of undesirable adverse effects, such as respiratory depression, nausea, and vomiting. In recent years, regional anesthesia techniques, including intercostal nerve blocks (ICNBs), have been implemented in children undergoing the Nuss procedure 8,9. The advantages of ICNBs include technical simplicity, good analgesia, an opioid-sparing effect, improved pulmonary mechanics, reduced central nervous system (CNS) depression, and avoidance of urinary retention 10.…”

A retrospective comparison of thoracic epidural infusion and multimodal analgesia protocol for pain management following the minimally invasive repair of pectus excavatum

“…Additionally, some have questioned whether the added cost and failure rate with epidural analgesia is justified by the reduction in early pain scores postoperatively . More recently some have advocated reliance on multimodal analgesia protocols or alternative regional techniques including paravertebral catheters, intercostal blocks, and continuous chest wall infusions …”

“…7 Additionally, some have questioned whether the added cost and failure rate with epidural analgesia is justified by the reduction in early pain scores postoperatively. 18 More recently some have advocated reliance on multimodal analgesia protocols 12 or alternative regional techniques including paravertebral catheters, 9,10,19 intercostal blocks, 11,20 and continuous chest wall infusions. 8 Multimodal analgesia, the use of a variety of analgesic medications and techniques to target different pain mechanisms, is recommended for the treatment of postoperative pain in children.…”

Anaesthetic considerations for pectus repair surgery

“…Again larger randomised controlled studies in adult patients are lacking. Nonetheless, there is evidence of reduced post-operative opiate requirement after intercostal blocks in paediatric population (84). Despite this bilateral intercostal blocks have been used in combination with multimodal analgesic techniques in adults (85,86) in pectus surgery.…”