Article description

Summary:

• To assess whether a preoperative bilateral thoracic paravertebral block (TPVB) would improve postoperative analgesia in infants and small children undergoing open cardiac surgery in ultra-fast track cardiac anesthesia (UFTCA) protocol.
• single-center, prospective, randomized, controlled study.
• The study analyzed 180 children undergoing cardiac surgery on bypass, 90 per group
• Inclusion criteria: American Society of Anesthesiologists (ASA) grades I to III, risk adjustment for congenital heart surgery15 (RACHS) grades 1 to 3, age between 1 month and three years, and weighing >5 kg.
• Exclusion criteria: neonates, ASA grades IV to V, RACHS grades 4 to 6, weighing <5 kg, children undergoing emergency surgery, severe pneumonia before surgery, severe liver or kidney dysfunction, severe central nervous system disease, atrioventricular block, or an allergy to amide local anesthetics.
• Intervention: patients were allocated randomly to preoperative bilateral thoracic paravertebral block (TPVB, single shot 0.2% ropivacaine, 0.5 mL/kg) and parent- and/or nurse-controlled intravenous analgesia (PNCA) group (Group T) or PNCA group (Group P).
• 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 (the latter two as markers of stress) were all significantly lower in the TPVB group.
• The time to extubation, the use of neostigmine, and PaCO2 on the sixth hour, postoperatively, were significantly smaller in the TPVB group. There were no significant differences in hospitalizations between the two groups.

Conclusions:

• In this particular setting of ultra-fast-track-cardiac anesthesia, a combination of bilateral single-dose TPVB and PNCA pain management seemed beneficial in infants and small children undergoing open cardiac surgery.