Post-thoracotomy pain relief in pediatric patients epidural versus inter-pleural analgesia

El-Aziz, Muhammad A Abd; Elnakera, Abeer M.; Salah, A.

doi:10.4103/2356-9115.178900

Cited by 3 publications

(2 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results from group B show the duration of analgesia as being similar to that reported by many other studies (4.7 ± 1) [11,12]. In contrast, in the Abd El-Aziz et al [13] study, a total of 80 pediatric patients underwent elective thoracotomy and were assigned either to receive thoracic epidural analgesia or IP analgesia. They used bupivacaine 1.5 mg/kg in 0.25% concentration, and found the time to first rescue analgesia was shorter in the IP group compared to our study (2.7 ± 0.9) as they used a lower drug concentration.…”

Section: Discussionsupporting

confidence: 89%

Small dose of naloxone as an adjuvant to bupivacaine in intrapleural infiltration after thoracotomy surgery: a prospective, controlled study

Amer

Omara

2019

Korean J Pain

View full text Add to dashboard Cite

Background Severe pain always develops after thoracotomy; intrapleural regional analgesia is used as a simple, safe technique to control it. This study was performed to evaluate whether a small dose of naloxone with local anesthetics prolongs sensory blockade. Methods A prospective, randomized double-blinded controlled study was conducted on 60 patients of American Society of Anesthesiologists statuses I and II, aged 18 to 60 years, scheduled for unilateral thoracotomy surgery. After surgery, patients were randomly divided into two groups: through the intrapleural catheter, group B received 30 ml of 0.5% bupivacaine, while group N received 30 ml of 0.5% bupivacaine with 100 ng of naloxone. Postoperative pain was assessed using the visual analog pain scale (VAS). Time for the first request for rescue analgesia, total amount consumed, and incidence of postoperative complications were also recorded. Results The VAS score significantly decreased in group N, at 6 h and 8 h after operation ( P < 0.001 for both). At 12 h after injection, the VAS score increased significantly in group N ( P < 0.001). The time for the first request of rescue analgesia was significantly longer in group N compared to group B ( P < 0.001). The total amount of morphine consumed was significantly lower in group N than in the bupivacaine group ( P < 0.001). Conclusions Addition of a small dose of naloxone to bupivacaine in intrapleural regional analgesia significantly prolonged pain relief after thoracotomy and delayed the first request for rescue analgesia, without significant adverse effects.

show abstract

Section: Discussionsupporting

confidence: 89%

Small dose of naloxone as an adjuvant to bupivacaine in intrapleural infiltration after thoracotomy surgery: a prospective, controlled study

Amer

Omara

2019

Korean J Pain

View full text Add to dashboard Cite

show abstract

“…Epidurals have been shown to reduce postoperative serum catecholamine, glucose, and adrenocorticotropic hormone (ACTH) levels more effectively than intravenous opioid in children [27] and modulate the hormonal stress response to surgery in patients of all ages, including after cardiac surgery [28,29,30,31,32]. Thoracic epidural analgesia has even been described as superior to interpleural analgesia following coarctation repair in adults [33,34,35]. Despite the potential benefits of epidurals for coarctation repair in children, we could identify only one case report describing three children with epidurals for coarctation repair [36], and one case report describing a child with an epidural for coarctation repair who developed transient Horner syndrome [37].…”

Section: Introductionmentioning

confidence: 99%

Epidurals for Coarctation Repair in Children Are Associated with Decreased Postoperative Anti-Hypertensive Infusion Requirement as Measured by a Novel Parameter, the Anti-Hypertensive Dosing Index (ADI)

et al. 2019

View full text Add to dashboard Cite

Background: Sympathetically-associated hypertension after coarctation repair is a common problem often requiring anti-hypertensive infusions in an intensive care unit. Epidurals suppress sympathetic output and can reduce blood pressure but have not been studied following coarctation repair in children. We sought to determine whether epidurals for coarctation repair in children were associated with decreased requirement for postoperative anti-hypertensive infusions, if they were associated with changes in hospital course, or with complications. Methods: In this observational retrospective cohort study, we evaluated all patients age 1–18 years undergoing coarctation repair at our institution during a 10-year period and compared the requirement for postoperative anti-hypertensive infusions in patients with and without epidurals using an anti-hypertensive dosing index (ADI) incorporating total dose-hours of all anti-hypertensive infusions (primary outcome). We also assessed intensive care unit (ICU) and hospital length of stay, discharge on oral anti-hypertensive medication, and complications potentially related to epidurals (secondary outcomes). Results: Children undergoing coarctation repair with epidurals had decreased requirements for postoperative anti-hypertensive infusions compared to children without epidurals (cumulative ADI 65.0 [28.5–130.3] v. 157.0 [68.6–214.7], p = 0.021; mean ADI 49.0 [33.3–131.2] v. 163.0 [66.6–209.8], p = 0.01). After multivariable cumulative logit mixed-effects regression analysis, mean ADI was decreased in patients with epidurals throughout the postoperative period (p < 0.001). Patients with epidurals were 1.6 years older and weighed 10.6 kg more than patients without epidurals but were otherwise comparable. Epidural complications included pruritus (three patients), agitation (one patient), somnolence (one patient), and transient orthostatic hypotension (one patient). Duration of intensive care unit admission, duration of hospital stays, and requirement for anti-hypertensive medication at discharge were similar in patients with and without epidurals. Conclusions: This is the first study of children receiving an epidural for surgical repair of aortic coarctation via open thoracotomy. In this small, single-institution, observational retrospective cohort study, epidurals for coarctation repair in children were associated with decreased postoperative anti-hypertensive infusion requirements. Epidurals were not associated with length of ICU or hospital stay, or with discharge on anti-hypertensive medication. No significant epidural complications were noted. Prospective study of larger populations will be necessary to confirm these associations, address causality, verify safety, and assess other effects.

show abstract

Continuous Erector Spinae Plane Catheter for Analgesia After Infant Thoracotomy: A Case Report

Kaplan

Jiao²,

AuBuchon³

et al. 2018

A&A Practice

View full text Add to dashboard Cite

The erector spinae plane block is an emerging technique for the provision of thoracolumbar analgesia with reported pediatric applications. We describe the placement of a continuous erector spinae plane catheter at the T5-T6 level in a 7-month-old infant who was undergoing thoracotomy for left upper lobectomy due to congenital pulmonary airway malformation. This technique resulted in outstanding analgesia without the need for opioid rescue analgesia. This block has a low degree of technical difficulty and is placed in area devoid of nearby critical structures and could be used in a number of potentially painful interventions.

show abstract

Post-thoracotomy pain relief in pediatric patients epidural versus inter-pleural analgesia

Cited by 3 publications

References 1 publication

Small dose of naloxone as an adjuvant to bupivacaine in intrapleural infiltration after thoracotomy surgery: a prospective, controlled study

Small dose of naloxone as an adjuvant to bupivacaine in intrapleural infiltration after thoracotomy surgery: a prospective, controlled study

Epidurals for Coarctation Repair in Children Are Associated with Decreased Postoperative Anti-Hypertensive Infusion Requirement as Measured by a Novel Parameter, the Anti-Hypertensive Dosing Index (ADI)

Continuous Erector Spinae Plane Catheter for Analgesia After Infant Thoracotomy: A Case Report

Contact Info

Product

Resources

About