Can thoracic paravertebral block replace thoracic epidural block in pediatric cardiac surgery? A randomized blinded study

Abstract

To compare the outcomes of thoracic epidural block with thoracic paravertebral block for thoracotomy in pediatric patients. A prospective double-blind study. 60 pediatric patients aged 1-24 months, ASA II, III scheduled for thoracotomy were randomly allocated into two groups. After induction of general anesthesia, thoracic epidural catheter was inserted in group E (epidural) patients and thoracic paravertebral catheter was inserted in group P (paravertebral) patients. Post operative pain score was recorded hourly for 24 hours. Plasma cortisol level was recorded at three time points. Tidal breathing analysis was done preoperatively and 6 hours postoperatively. Analgesia, serum cortisol level, and pulmonary function parameters were comparable in the two groups. However, failure rate (incorrect placement of catheter) was significantly higher in epidural group than in paravertebral group (7% versus 0%, respectively). The complications were also significantly higher in epidural group (vomiting 14.8%, urine retention 11.1% and hypotension 14.8%) than paravertebral group (0%, 0%, and 3.6%, respectively). We conclude that both thoracic paravertebral block and thoracic epidural block results in comparable pain score and pulmonary function after thoracotomy in pediatric patients; the paravertebral block is associated with significantly less failure rate and side effects.

Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children

“…All participants received local ropivacaine administration at the edges of the thoracotomy and chest drainage orifices and in the inter pleural space postoperatively (thus no control group) Eisenach 2010 RCT comparing intrathecal bupivacaine with ketoralac vs saline for prevention of postoperative pain. All participants received intrathecal bupivacaine thus no control group El-Morsy 2012 Randomized, blinded study comparing outcome of paravertebral block vs thoracic epidural block for post-thoracotomy incision pain in paediatric patients. The primary objective was evaluation of immediate postoperative analgesia.…”

Applications of regional anaesthesia in paediatrics

“…74 Ultrasound-guided paravertebral block has been utilized for postoperative pain management in children undergoing thoracic and cardiac surgery procedures. 75 Lonnqvist described continuous paravertebral block as a viable option for extended postoperative analgesia. 76 Technique The patient is placed in the lateral or prone position.…”

Ultrasound-guided thoracic paravertebral block catheter experience in 2 neonates

“…Previous reports of extrapleural and TPVB catheter infusions in the newborn period have limited infusion of 24-48 hours [1,2,7,9]. Older children have received infusions for up to 5 days including the early report by Eng and Sabanathan [10] in 1992 where 6 children aged 7-16 had paravertebral catheters infused with 0.5% bupivacaine at 0.2 mL/kg per hour for up to 5 days.…”

“…A recent report by El-Morsy et al [2] of 60 infants aged 1-24 months randomized to thoracic epidural or landmark-based TPVB catheter placement showed equivalent analgesia for thoracotomy and reduced side effects.…”