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Role of dexamethasone in the para-vertebral block for pediatric patients undergoing aortic coarctation repair.

Amany H Saleh^1,2, Passaint F Hassan³, Mohamed Elayashy³

¹Department of Anesthesia , Surgical Intensive Care and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. dr_amanyhassan@hotmail.com.

BMC Anesthesiology

|December 4, 2018

Insights

Adding dexamethasone to bupivacaine in ultrasound-guided paravertebral blocks significantly prolonged postoperative analgesia and reduced complications in pediatric aortic coarctation surgery patients. This anesthesia technique improves pain management and recovery.

Area of Science:

Anesthesiology
Pediatric Surgery
Pain Management

Background:

Aortic coarctation surgery necessitates careful anesthesia management due to severe pain and hemodynamic instability.
Effective pain control and postoperative care are critical for patient recovery.

Purpose of the Study:

To compare the efficacy of ultrasound-guided paravertebral block using bupivacaine alone versus bupivacaine with dexamethasone.
To evaluate intra- and postoperative analgesic requirements, hemodynamics, complications, and ICU stay.

Main Methods:

A prospective, randomized, double-blinded study involving 50 pediatric patients (4-12 months) undergoing aortic coarctation repair.
Patients received either bupivacaine with dexamethasone or bupivacaine alone via paravertebral block.
Data collected included intraoperative fentanyl use, hemodynamics, postoperative pain scores, time to analgesia request, extubation time, and complications.

Main Results:

The dexamethasone group showed significantly lower postoperative pain scores at 12 and 24 hours.
Patients receiving dexamethasone had a significantly longer time to their first analgesic request.
The dexamethasone group also experienced a significantly shorter time to extubation.

Conclusions:

Dexamethasone as an adjuvant to bupivacaine in paravertebral blocks enhances postoperative analgesia duration in pediatric aortic coarctation surgery.
This combination therapy leads to a reduced incidence of postoperative complications.
Ultrasound-guided paravertebral block with dexamethasone offers improved pain management and recovery outcomes.

Read full analysis

Abstract

Background:

Surgery for aortic coarctation requires special care during anesthesia due to severe pain during the lateral thoracotomy incision, intraoperative hemodynamic instability and the need for large doses of intra- and postoperative analgesics and vasodilators. Additionally, the postoperative care of patients is very important.

Aims:

We aimed to compare ultrasound-guided paravertebral block performed using bupivacaine alone and bupivacaine with dexamethasone in terms of the intra- and postoperative analgesic requirements and hemodynamics, postoperative complications and ICU stay.

Study Design:

This was a prospective, randomized, controlled, double-blinded study.

Methods:

Fifty patients aged four to 12 months scheduled for aortic coarctation surgery were randomly divided into two equal groups (n = 25). Patients in group D (dexamethasone) received 0.5 mg/kg bupivacaine 0.25% mixed with 0.1 mg/kg dexamethasone diluted with isotonic saline and those in group C (control) received 0.5 mg/kg bupivacaine 0.25% diluted with isotonic saline (total volume 15 ml in each group). Intraoperative fentanyl consumption and hemodynamics (heart rate, arterial blood pressure) at baseline, 1 min after induction, at skin incision, after 30 min, after clamping, after declamping and at the end of the surgery were recorded, along with the objective pain score (OPS) immediately postoperatively and at 4 h, 8 h, 12 h and 24 h postoperatively and the time to the first request for pethidine. The intra- and postoperative vasodilator doses, time to extubation, ICU stay duration and postoperative complications were also recorded.

Results:

The postoperative OPS was significantly lower at 12 and 24 h in group D than in group C. The time to the first request for analgesia was significantly longer in group D than in group C (3.9 ± 2.23 vs 8.6 ± 0.69). Additionally, the time to extubation was significantly shorter in group D.

Conclusion:

The use of dexamethasone as an adjuvant in ultrasound-guided paravertebral block in paediatric patients undergoing surgery for aortic coarctation increased the duration of postoperative analgesia with a prolonged time to the first request for analgesics It was also associated with a decreased incidence of postoperative complications.

Trial Registration:

Trial registration number: NCT03074773 . (Prospectively registered). The initial registration date was 9/3/2017.

Keywords:

Aortic coarctation OPS Paravertebral block Ultrasound guidance

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