Efficacy of paravertebral block in “Fast-tracking” pediatric cardiac surgery - Experiences from a tertiary care center

Abstract

Introduction: Fast tracking plays a crucial role in reducing perioperative morbidity and financial burden by facilitating early extubation and discharge from hospital. Paravertebral block (PVB) is becoming more popular in paediatric surgeries as an alternative to epidural and caudal analgesia. There is scarcity of data regarding the efficacy and safety of PVB in paediatric cardiac surgery. Methods: We performed a review of records of paediatric cardiac patients who underwent cardiac surgery under general anaesthesia with single shot PVB and compared the analgesia and postoperative outcomes with matched historical controls who underwent cardiac surgery with same anaesthesia protocol without PVB. Results: The data from 200 children were analysed. 100 children who received paravertebral block were compared with a matched historical controls. The median time to extubation was shorter in the PVB group (0 hr, IQR 0-3 hrs) compared to the control group (16 hrs, IQR 4-20 hrs) ( P value 0.017*). Intraoperative and postoperative fentanyl requirement was much lower in the PVB group (3.49 (0.91)) compared to the control group (9.86 (1.37)) P value <0.01*. Time to first rescue dose of analgesic was longer (7 hrs vs 5 hrs, P 0.01*), while time to extubation and duration of ICU stay were significantly less in PVB group . Mean postoperative pain scores were significantly lower in the PVB group at the time of ICU admission (0.85 vs 3.12, P 0.001*) till 4 hours (2.11 vs 3.32, P 0.001*). Conclusion: PVB provides an effective and safe anaesthetic approach which can form an important component of “fast-track” care in paediatric cardiac surgery.

Comparison of ultrasound-guided thoracic erector spinae plane block versus paravertebral block for analgesia after pediatric cardiac surgery

“…The current study showed the non-inferiority of single shot ESPB to PVB in providing postoperative analgesia after cardiac surgery. Paravertebral block has been shown to provide effective analgesia in terms of opioid consumption and pain scores after cardiac surgery [2], [5]- [7] To the best of our knowledge, this is the first randomized clinical trial that compared the effects of ESPB and PVB on postoperative analgesia after cardiac surgery. Kaushal B, et al performed bilateral thoracic ESPB in 40 pediatric patients who underwent cardiac surgery via median sternotomy and compared its postoperative analgesic effects with those of patients with no block, they found that ESPB was associated with superior and effective postoperative analgesia compared with the control [12].…”

“…Paravertebral block (PVB) has gained more popularity than other regional analgesic techniques including caudal and epidural for perioperative analgesia in pediatric cardiac surgery [2]. Thoracic paravertebral block provides adequate postoperative analgesia with favorable adverse effects [3], [4].…”

“…Thoracic paravertebral block provides adequate postoperative analgesia with favorable adverse effects [3], [4]. The use of thoracic PVB in cardiac surgery is associated with decreased pain severity and opioid consumption in both adults [5], [6] and children [2], [7].…”

Regional anesthesia as part of enhanced recovery strategies in pediatric cardiac surgery

“…The ESPB targets the tips of transverse processes, whereas the RLB targets the laminae [ 60 ]. The PVB targets the paravertebral space [ 61 ]. The injected local anesthetic spreads several segments cephalad and caudal along the musculofascial plane between the paraspinal back muscles and underlying thoracic vertebrae [ 60 ].…”

“…However, ESPB and RLB can also be easily performed in a blinded fashion by injecting a local anesthetic at the point where the puncture needle is applied to the transverse process of the vertebra (Fig. 2 ), while the real-time ultrasound guidance technique is essential for PVB [ 61 ].…”