Atrial septal defect closure via mini-thoracotomy in pediatric patients: Postoperative analgesic effect of intercostal nerve block
Date
2020-01-01
Journal Title
Journal ISSN
Volume Title
Publisher
BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK
Abstract
Background: In this study, we evaluated the efficacy of intercostal nerve block for postoperative pain management in pediatric patients undergoing atrial septal defect closure through a right lateral mini-thoracotomy. Methods: Between January 2016 and January' 2019. a total of 63 pediatric patients (37 males, 26 females: mean age 34.8 +/- 26.8 months
range. 2 to 96 months) who underwent corrective congenital heart surgery for atrial septa! defect closure through a right lateral mini-thoracotomy were retrospectively reviewed. The patients were divided into two groups as those (Group 1, n=33) receiving intercostal nerve block and general anesthesia and those (Group 2, n=30) receiving general anesthesia alone. Intravenous morphine at a dose of 0.03 mg/kg was applied as rescue analgesia to the patients with a Ramsay Sedation Scale score of >4 and Children's Hospital of Eastern Ontario Pain Scale score of >7. The total analgesic requirement, adverse effects, duration of mechanical ventilation and length of stay in the intensive care unit were recorded. Results: The mean duration of mechanical ventilation and intensive care unit stay was shorter in Group 1 compared to Group 2 (3.6 +/- 1.3 vs. 9.4-12.1 h
23 +/- 2.6 vs. 30 +/- 7.2 h, respectively) (p<0.0001). The need for postoperative rescue analgesia was statistically significantly lower in Group 1 compared to Group 2 (0.3 +/- 0.5 mg vs. 1.1 +/- 0.9 mg, respectively) (p=0.003). The mean total morphine consumption was also lower in Group 1 compared to Group 2 (4.0 +/- 2.2 mg vs. 9.0 +/- 3.4 mg, respectively) (p<0.0001). Conclusion: Intercostal nerve block before thoracotomy closure in pediatric patients undergoing atrial septal defect repair under mini-thoracotomy provides early extubation, shorter mechanical ventilation duration and intensive care unit stay, and reduced analgesic requirements.
range. 2 to 96 months) who underwent corrective congenital heart surgery for atrial septa! defect closure through a right lateral mini-thoracotomy were retrospectively reviewed. The patients were divided into two groups as those (Group 1, n=33) receiving intercostal nerve block and general anesthesia and those (Group 2, n=30) receiving general anesthesia alone. Intravenous morphine at a dose of 0.03 mg/kg was applied as rescue analgesia to the patients with a Ramsay Sedation Scale score of >4 and Children's Hospital of Eastern Ontario Pain Scale score of >7. The total analgesic requirement, adverse effects, duration of mechanical ventilation and length of stay in the intensive care unit were recorded. Results: The mean duration of mechanical ventilation and intensive care unit stay was shorter in Group 1 compared to Group 2 (3.6 +/- 1.3 vs. 9.4-12.1 h
23 +/- 2.6 vs. 30 +/- 7.2 h, respectively) (p<0.0001). The need for postoperative rescue analgesia was statistically significantly lower in Group 1 compared to Group 2 (0.3 +/- 0.5 mg vs. 1.1 +/- 0.9 mg, respectively) (p=0.003). The mean total morphine consumption was also lower in Group 1 compared to Group 2 (4.0 +/- 2.2 mg vs. 9.0 +/- 3.4 mg, respectively) (p<0.0001). Conclusion: Intercostal nerve block before thoracotomy closure in pediatric patients undergoing atrial septal defect repair under mini-thoracotomy provides early extubation, shorter mechanical ventilation duration and intensive care unit stay, and reduced analgesic requirements.
Description
Keywords
Atrial septal defect, intercostal nerve block, mini thoracotomy, pediatric cardiac surgery, postoperative analgesia