Interpleural bupivacaine and intravenous oxycodone for pain treatment after thoracotomy in children

Area of Science:

• Pediatric Anesthesiology
• Pain Management
• Thoracic Surgery

Background:

• Post-thoracotomy pain management in children often yields inconclusive results.
• This pilot study investigated interpleural bupivacaine and IV oxycodone for pain control in pediatric patients.
• Evaluated 10 children (10 months-12 years) with patent ductus arteriosus undergoing thoracotomy.

Purpose of the Study:

• To assess the efficacy and safety of interpleural bupivacaine combined with IV oxycodone for post-thoracotomy pain relief in children.
• To determine if scheduled non-opioid analgesia supplemented with interpleural bupivacaine is sufficient for pediatric thoracotomy pain.
• To evaluate the role of IV oxycodone as a rescue analgesic in this patient population.

Main Methods:

• Children received rectal ibuprofen (10 mg/kg) every six hours post-surgery.
• Interpleural bupivacaine (2 mg/kg initially, then 1 mg/kg) was administered post-surgery and as needed based on pain scores (≥4/11).
• Intravenous oxycodone (0.1 mg/kg) was used for rescue analgesia if pain was inadequately controlled.

Main Results:

• All 10 children required both interpleural bupivacaine and IV oxycodone for pain management.
• The mean number of bupivacaine doses was 6.1 (SD=2.3), and oxycodone doses was 6.0 (SD=3.6).
• No serious adverse events, including respiratory depression or decreased oxygen saturation, were observed.

Conclusions:

• Scheduled ibuprofen with interpleural bupivacaine was insufficient for managing post-thoracotomy pain in young children.
• Intravenous oxycodone served as an effective and safe opioid adjunct to the multimodal pain regimen.
• This study highlights the need for effective opioid supplementation in pediatric post-thoracotomy pain management.