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Somatic paravertebral block decreases opioid requirements in children undergoing appendectomy

William M Splinter1, Margaret E Thomson

  • 1Department of Anesthesia, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada. splinter@cheo.on.ca

Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|January 12, 2010
PubMed

Insights

Somatic paravertebral block (SPVB) in children undergoing appendectomy significantly reduced opioid use and improved pain management compared to no block. This pediatric pain relief method showed promising results with no significant increase in adverse effects.

Area of Science:

  • Pediatric Anesthesiology
  • Regional Anesthesia Techniques
  • Pain Management in Children

Background:

  • Somatic paravertebral block (SPVB) is recognized for effective and prolonged nerve blockade.
  • Limited studies exist on SPVB's application and efficacy in pediatric populations.
  • Appendectomy in children presents a common surgical scenario for pain management evaluation.

Purpose of the Study:

  • To compare the efficacy of somatic paravertebral block (SPVB) versus no block in pediatric patients undergoing appendectomy.
  • To evaluate the impact of SPVB on postoperative pain control and opioid requirements in children.

Main Methods:

  • A prospective randomized controlled study involving 36 children (3-16 years) undergoing open appendectomy.
  • Group I received a preoperative right SPVB with ropivacaine and epinephrine; Group II (Control) received no block.
  • Pain was managed with morphine, acetaminophen, and ketorolac; time to first morphine dose and 24-hour morphine consumption were primary outcomes.

Main Results:

  • SPVB group required significantly less morphine (0.12 ± 0.07 mg/kg) compared to the control group (0.34 ± 0.15 mg/kg; P < 0.001).
  • Time to the first morphine dose was significantly longer in the SPVB group (7.1 ± 4.4 hours) versus the control group (2.5 ± 1.6 hours; P < 0.001).
  • Vomiting incidence was 11% in the SPVB group and 27% in the control group (P = 0.21); no other significant adverse effects were noted.

Conclusions:

  • Somatic paravertebral block (SPVB) offers superior pain relief in children undergoing appendectomy compared to no block.
  • SPVB significantly reduces the need for opioid analgesics post-appendectomy in pediatric patients.
  • The incidence of side effects was comparable between the SPVB and control groups, suggesting a favorable safety profile.
Abstract

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