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

GamalZ El-Morsy, Tariq El-Desouky, AshrafA Elsharkawy, MohamedAdel F Elgamal, Alaa El-Deeb
2012 Annals of Cardiac Anaesthesia  
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
more » ... as 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. ABSTRACT Original Article limit its utility. In a population of pediatric patients, risks are possibly higher due to the placement of these catheters under general anesthesia. Therefore, an alternative but equally effective method of analgesia would be preferable. Despite studies showing that paravertebral blockade provides equal postoperative analgesic benefits with lower side effects than epidural in adults, evidence is lacking in pediatric patients. [6] [7] This study was conducted to compare outcome of paravertebral block versus thoracic epidural block for post-thoracotomy incision pain in pediatric patients. The primary objective was evaluation of postoperative analgesia. Secondary objectives included hormonal responses, side effects, failure rate, and pulmonary function.
doi:10.4103/0971-9784.101848 pmid:23041682 fatcat:2m5khpslerexngmlj6jhwrnety