Atrial septal defect closure via mini-thoracotomy in pediatric patients: Postoperative analgesic effect of
Dilek Altun1, Abdullah Doğan2, Ahmet Arnaz3
1Department of Anesthesiology and Reanimation, Acıbadem Mehmet Ali Aydınlar University, Vocational School of Health Sciences, Istanbul, Turkey.
Insights
Intercostal nerve block significantly improves postoperative pain management in pediatric atrial septal defect repair. This method reduces mechanical ventilation duration, intensive care unit stay, and analgesic needs in young patients.
Area of Science:
- Pediatric Cardiac Surgery
- Pain Management
- Anesthesiology
Background:
- Pediatric patients undergoing atrial septal defect closure via mini-thoracotomy experience significant postoperative pain.
- Effective pain management is crucial for recovery and reducing complications.
Purpose of the Study:
- To evaluate the efficacy of intercostal nerve block for postoperative pain control in pediatric patients undergoing atrial septal defect repair.
- To compare outcomes between patients receiving intercostal nerve block and those receiving general anesthesia alone.
Main Methods:
- Retrospective review of 63 pediatric patients (2-96 months) who had atrial septal defect closure.
- Patients were divided into two groups: intercostal nerve block with general anesthesia (Group 1) and general anesthesia alone (Group 2).
- Rescue analgesia (morphine) was administered based on pain and sedation scores. Outcomes included analgesic requirements, adverse effects, ventilation duration, and ICU stay.
Main Results:
- Group 1 showed significantly shorter mechanical ventilation duration (3.6±1.3 h) and ICU stay (23±2.6 h) compared to Group 2 (9.4±2.1 h and 30±7.2 h, respectively).
- Postoperative rescue analgesia requirement was significantly lower in Group 1 (0.3±0.5 mg) versus Group 2 (1.1±0.9 mg).
- Mean total morphine consumption was also significantly reduced in Group 1 (4.0±2.2 mg) compared to Group 2 (9.0±3.4 mg).
Conclusions:
- Intercostal nerve block before thoracotomy closure in pediatric patients undergoing atrial septal defect repair facilitates early extubation.
- This technique leads to shorter mechanical ventilation duration and reduced intensive care unit stay.
- Intercostal nerve block effectively reduces postoperative analgesic requirements in pediatric patients undergoing this procedure.
Background:
In this study, we evaluated the efficacy of intercostal nerve block for postoperative pain management in pediatric patients undergoing atrial septal defect closure through a right lateral mini-thoracotomy.
Methods:
Between January 2016 and January 2019, a total of 63 pediatric patients (37 males, 26 females; mean age 34.8±26.8 months; range, 2 to 96 months) who underwent corrective congenital heart surgery for atrial septal defect closure through a right lateral mini-thoracotomy were retrospectively reviewed. The patients were divided into two groups as those (Group 1, n=33) receiving intercostal nerve block and general anesthesia and those (Group 2, n=30) receiving general anesthesia alone. Intravenous morphine at a dose of 0.03 mg/kg was applied as rescue analgesia to the patients with a Ramsay Sedation Scale score of >4 and Children"s Hospital of Eastern Ontario Pain Scale score of >7. The total analgesic requirement, adverse effects, duration of mechanical ventilation and length of stay in the intensive care unit were recorded.
Results:
The mean duration of mechanical ventilation and intensive care unit stay was shorter in Group 1 compared to Group 2 (3.6±1.3 vs. 9.4±2.1 h; 23±2.6 vs. 30±7.2 h, respectively) (p<0.0001). The need for postoperative rescue analgesia was statistically significantly lower in Group 1 compared to Group 2 (0.3±0.5 mg vs. 1.1±0.9 mg, respectively) (p=0.003). The mean total morphine consumption was also lower in Group 1 compared to Group 2 (4.0±2.2 mg vs. 9.0±3.4 mg, respectively) (p<0.0001).
Conclusion:
Intercostal nerve block before thoracotomy closure in pediatric patients undergoing atrial septal defect repair under mini-thoracotomy provides early extubation, shorter mechanical ventilation duration and intensive care unit stay, and reduced analgesic requirements.
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