Intravenous Morphine Infusion versus Thoracic Epidural Infusion of Ropivacaine with Fentanyl after the Ravitch...

Area of Science:

• Pediatric Anesthesiology
• Pain Management
• Thoracic Surgery

Background:

• The Ravitch procedure, a surgical intervention for pectus excavatum, necessitates effective postoperative pain management.
• Optimizing analgesia in pediatric patients is crucial for recovery and reducing complications.

Purpose of the Study:

• To compare the efficacy of intravenous morphine infusion versus thoracic epidural infusion of ropivacaine with fentanyl for postoperative analgesia in pediatric patients undergoing the Ravitch procedure.

Main Methods:

• A comparative study involving two groups of pediatric patients: intravenous morphine infusion (n=56) and thoracic epidural ropivacaine with fentanyl (n=40).
• Pain scores (Numerical Rating Scale), rescue medication consumption, anxiety, side effects, and patient satisfaction were assessed from postoperative day 0 to day 3.
• A multimodal pain management protocol including paracetamol, NSAIDs, and metamizole as rescue was employed.

Main Results:

• Patients receiving intravenous morphine reported significantly lower average and maximal pain scores at rest, during deep breathing, and coughing compared to the epidural group (p < 0.05).
• The intravenous morphine group required significantly fewer doses of the rescue analgesic metamizole (median 1 vs. 3; p = 0.003).
• No significant differences were observed in anxiety levels, postoperative side effects, or patient satisfaction between the two groups (p > 0.05).

Conclusions:

• Intravenous morphine infusion demonstrated superior postoperative analgesia compared to thoracic epidural infusion of ropivacaine with fentanyl in pediatric patients after the Ravitch procedure.
• The findings suggest that intravenous morphine may be a more effective option for managing pain in this specific patient population.