Objectives
To assess whether a preoperative bilateral thoracic paravertebral block (TPVB) would
improve postoperative analgesia in infants and small children undergoing open cardiac
surgery in the protocol of an ultra-fast track cardiac anesthesia (UFTCA).
Design
A single-center, prospective, randomized, controlled study.
Setting
At a tertiary children's medical center.
Participants
A total of 180 children undergoing cardiac surgery, aged 1 month to 3 years.
Interventions
Patients are allocated randomly to TPVB and parent- and/or nurse-controlled intravenous
analgesia (PNCA) group (Group T) or PNCA group (Group P).
Measurements and Main Results
The primary outcome is the postoperative pain scores. The secondary outcome are intraoperative
consumption of sufentanil, time to extubation, using of neostigmine, cumulative total
and invalid PCA attempts in 24 and 48 hours after surgery, hospitalization characteristics,
perioperative blood glucose, postoperative arterial oxygen partial pressure, arterial
carbon dioxide partial pressure (PaCO2) and brain natriuretic peptide (BNP). The postoperative pain scores within 24 hours,
intraoperative consumption of sufentanil, total, and invalid PCA attempts in 24 and
48 hours, perioperative blood glucose and BNP on the seventh day in Group T were all
significantly lower than those in Group P (p < 0.001). The time to extubation, the use of neostigmine, and PaCO2 on the sixth hour, postoperatively, were significantly smaller in Group T than those
in Group P (p < 0.05). There were no significant differences in the hospitalizations between the 2 groups.
Conclusions
A combination of bilateral single dose TPVB and PNCA pain management is superior to
a PNCA pain management alone in infants and small children undergoing open cardiac
surgery and contributes to a rapid recovery with preferable perioperative outcomes
in the protocol of UFTCA.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiothoracic and Vascular AnesthesiaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Efficacy of bilateral pectoralis nerve block for ultrafast tracking and postoperative pain management in cardiac surgery.Ann Card Anaesth. 2018; 21: 333-338
- Can thoracic paravertebral block replace thoracic epidural block in pediatric cardiac surgery? A randomized blinded study.Ann Card Anaesth. 2012; 15: 259-263
- Pain management after cardiac surgery.Semin Cardiothorac Vasc Anesth. 2010; 14: 201-204
- Benefits of ultra-fast-track anesthesia for children with congenital heart disease undergoing cardiac surgery.BMC Pediatr. 2019; 19: 487
- Ultra-fast-track extubation in adult congenital heart surgery.J Am Heart Assoc. 2021; 10e020201
- The effect of ultra-fast track cardiac anaesthesia in infants and toddlers: A randomised trial.Cardiol Young. 2022; 32: 1092-1097
- Ultra-fast-track anesthesia in off-pump coronary artery bypass grafting: A prospective audit comparing opioid-based anesthesia vs thoracic epidural-based anesthesia.Can J Anaesth. 2004; 51: 163-168
- Comparison of regional analgesia techniques for pleurodesis pain in pediatric patients.Paediatr Anaesth. 2020; 30: 1102-1108
- A comparison of paravertebral nerve block catheters and thoracic epidural catheters for postoperative analgesia following the Nuss procedure for pectus excavatum repair.Paediatr Anaesth. 2014; 24: 516-520
- A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy–a systematic review and meta-analysis of randomized trials.Br J Anaesth. 2006; 96: 418-426
- Anesthesia management with single injection paravertebral block for aorta coarctation in infant.Paediatr Anaesth. 2013; 23: 1078-1083
- Paravertebral block for thoracic Surgery.J Cardiothorac Vasc Anesth. 2018; 32: 915-927
- Comparison of erector spinae plane and paravertebral nerve blocks for postoperative analgesia in children after the Nuss procedure: Study protocol for a randomized controlled non-inferiority clinical trial.Trials. 2022; 23: 139
- Ultrasound-guided approach to the paravertebral space for catheter insertion in infants and children.Paediatr Anaesth. 2013; 23: 1193-1198
- Consensus-based method for risk adjustment for surgery for congenital heart disease.J Thorac Cardiovasc Surg. 2002; 123: 110-118
- Continuous thoracic paravertebral analgesia after minimally invasive atrial septal defect closure surgery in pediatric population: Effectiveness and safety analysis.Rev Esp Anestesiol Reanim (Engl Ed). 2022; 69: 259-265
- Benefits of ultra-fast-track anesthesia in left ventricular assist device implantation: A retrospective, propensity score matched cohort study of a four-year single center experience.J Cardiothorac Surg. 2017; 12: 10
- Ultrasound-guided thoracic paravertebral block experience in a child.Turk J Anaesthesiol Reanim. 2016; 44: 57-58
- Efficacy of preoperative bilateral thoracic paravertebral block in cardiac surgery requiring full heparinization: A propensity-matched study.J Cardiothorac Vasc Anesth. 2022; 36: 477-482
- A prospective randomized observer-blinded study to assess postoperative analgesia provided by an ultrasound-guided bilateral thoracic paravertebral block for children undergoing the Nuss procedure.Reg Anesth Pain Med. 2014; 39: 208-213
- The efficacy of caudal ropivacaine 1, 2 and 3 mg x l(-1) for postoperative analgesia in children.Paediatr Anaesth. 2002; 12: 53-58
- Local anesthetis and adjuvants in pediatric regional anesthesia.Curr Drug Targets. 2012; 13: 952-960
- Thoracic paravertebral block for nephrectomy: A randomized, controlled, observer-blinded study.Pain Med. 2014; 15: 850-856
- Efficacy of perineural dexamethasone with ropivacaine in thoracic paravertebral block for postoperative analgesia in elective thoracotomy: A randomized, double-blind, placebo-controlled trial.J Pain Res. 2018; 11: 1811-1819
- Thoracic paravertebral block ameliorates postoperative delirium in geriatric patients.Thorac Cardiovasc Surg. 2022; 70: 439-444
- A retrospective analysis of dexmedetomidine and morphine in the fast-track and ultra-fast-track extubation protocol after congenital cardiac surgery.J Card Surg. 2022; 37: 4234-4242
- Outcomes of dexmedetomidine treatment in pediatric patients undergoing congenital heart disease surgery: A meta-analysis.Paediatr Anaesth. 2016; 26: 239-248
- Preemptive ultrasound-guided paravertebral block and immediate postoperative lung function.Gen Thorac Cardiovasc Surg. 2015; 63: 43-48
- Use of neuromuscular blockers and neostigmine for general anesthesia and its association with neuraxial blockade: A retrospective study.Medicine (Baltimore). 2017; 96: e7322
- Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery.J Thorac Cardiovasc Surg. 2005; 130: 1144
- High thoracic epidural analgesia decreases stress hyperglycemia and insulin need in cardiac surgery patients.Acta Anaesthesiol Scand. 2013; 57: 171-177
- Acute pain induces insulin resistance in humans.Anesthesiology. 2001; 95: 578-584
- Usefulness of B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide as biomarkers for heart failure in young children with single ventricle congenital heart disease.Am J Cardiol. 2012; 109: 866-872
- B-type natriuretic peptide as a surrogate marker for survival in patients undergoing cardiac surgery.J Thorac Dis. 2021; 13: 955-967
Article info
Publication history
Published online: December 11, 2022
Footnotes
This work was supported by the National Science Foundation of China (grant numbers 81671116, 81870823), Health Science and Technology Project of Guangzhou (20231A011023).
Identification
Copyright
© 2022 Published by Elsevier Inc.
