Use of continuous retropleural bupivacaine in postoperative pain management for pediatric thoracotomy

The aim of this study was to evaluate the use of a continuous bupivacaine infusion into the retropleural space as an adjunct for postoperative pain management in pediatric thoracotomy.

A retrospective chart review was performed on 13 pediatric patients undergoing thoracotomy over a 3-year period (April 1995 through July 1997). In seven patients, insertion of a retropleural catheter was accomplished before closure of the thoracotomy by placing an epidural catheter posterior to the parietal pleura. This potential space was entered two intercostal levels below the incision and advanced superiorly four intercostal spaces. Bupivacaine (0.125% or 0.25%) was infused at 0.5 mL/kg/h. Postoperative intravenous narcotic requirement was compared between the study population (n = 7) and the control population (n = 6). Statistical analysis was conducted using the "separate" Student's t test.

Thirteen pediatric patients (age range, 7 to 18 years) were evaluated for total morphine use after thoracotomy. Seven patients had anterior spinal release and fusion, whereas five had mediastinal operations, and one patient had a lobectomy. The two groups were comparable in age, weight, and type of operation. Infusion through the retropleural catheter continued for an average of 3.8 days (range, 3 to 6 days). The total mean postoperative morphine requirement was 2.32 mg/kg (0.544 mg/kg/day) in the control population and 0.88 mg/kg (0.204 mg/kg/day) for the patients with a retropleural catheter (P<.001).

A continuous infusion of bupivacaine through a unique retropleural technique decreases the postoperative need for morphine in postoperative pediatric thoracotomy patients.