Thoracic Paravertebral Block for Postoperative Analgesia in Pediatric Oncology
https://doi.org/10.15360/1813-9779-2014-2-57-65
Abstract
Objective: to enhance the efficiency and safety of anesthesia during thoracic surgical interventions in pediatric cancer surgery, by using general anesthesia in combination with thoracic paravertebral analgesia.
Subjects and methods. A prospective, randomized trial was conducted. Intra- and postoperative data were analyzed in 90 patients who had been operated on for lung and thoracic malignancies. There were two patient groups: 1) 50 children who used continuous thoracic paravertebral block (PVB) with ropivacaine 0.3% as part of combined balanced anesthesia and 2) 40 children who received epidural block with ropivacaine 0.2% as an analgesic component of combined anesthesia. All the patients underwent hemodynamic monitoring; postoperative pain assessment were carried out by a visual analogue scale (VAS) in children above 3 years of age and by the modified Douleur Aigue du Nouveau-ne (DAN) scale in those below the age of 3 years.
Results. The trial has demonstrated that the analgesic effect during continuous PVB in the intra- and postoperative periods is comparable with that of epidural block with ropivacaine 0.2%; however, it has a higher hemodynamic stability. Ultrasound guided PVB has sufficient safety. The postoperative complications were pneumonia in 2 (4%) patients in the PVB group; these were associated with the baseline patient status in 5 (12.5%) children in the epidural analgesia group. Postoperative nausea was found in only 6% of the patients in the PVB group.
Conclusion. The proposed modification of ropivacaine 0.3% injection into the paravertebral space under ultrasound guidance can increase the extent of the local anesthetic, thus enhancing the efficiency of PVB. The efficiency of the block is 98.1% versus 86% of the given by foreign authors.
About the Authors
E. I. Belousova
Research Institute of Pediatric Oncology and Hematology, N. N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, Moscow
Russian Federation
Russian Federation
N. V. Matinyan
Research Institute of Pediatric Oncology and Hematology, N. N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, Moscow
Russian Federation
Russian Federation
Z. S. Ordukhanyan
Research Institute of Pediatric Oncology and Hematology, N. N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, Moscow
Russian Federation
Russian Federation
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For citations:
Belousova E.I., Matinyan N.V., Ordukhanyan Z.S. Thoracic Paravertebral Block for Postoperative Analgesia in Pediatric Oncology. General Reanimatology. 2014;10(2):57-65. https://doi.org/10.15360/1813-9779-2014-2-57-65
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