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Paravertebral Block Under Direct Vision Versus Local Anesthetic Infiltration for Pediatric Thoracoscopic Surgery

Meiling Jiang1, Wenjiao Huang1, Yang Yang1

  • 1Department of Pediatric Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.

Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
|May 10, 2023
PubMed

Insights

Direct visual paravertebral block (PVB) is a safe and effective method for managing postoperative pain in children with congenital lung malformations (CLMs). This technique significantly reduces rebound pain compared to local anesthetic infiltration (LAI).

Area of Science:

  • Pediatric Anesthesiology
  • Thoracic Surgery
  • Pain Management

Background:

  • Congenital lung malformations (CLMs) in children often require surgical intervention.
  • Evidence for the efficacy of direct visual paravertebral block (PVB) in pediatric CLM cases is limited.
  • Postoperative pain management is crucial for recovery in pediatric thoracic surgery.

Purpose of the Study:

  • To evaluate the effectiveness and safety of direct visual paravertebral block (PVB) for postoperative pain control in children with CLMs.
  • To compare the outcomes of PVB with local anesthetic infiltration (LAI) in this patient population.
  • To assess parameters such as rebound pain incidence, pain scores, and adverse events.

Main Methods:

  • A nonrandomized control study was conducted on pediatric patients (under 3 years) with CLMs undergoing thoracoscopic surgery.
  • Patients were divided into two groups: Group A received PVB analgesia, and Group B received local anesthetic infiltration (LAI).
  • Primary outcome was rebound pain incidence within 72 hours; secondary outcomes included FLACC pain scores, side effects, and family observation scores.

Main Results:

  • The incidence of rebound pain was significantly lower in the PVB group (10%) compared to the LAI group (60.5%) (P < .001).
  • PVB was associated with decreased FLACC pain scores at multiple time points, lower family observation scores, and fewer rebound pains (P < .001).
  • The LAI group experienced a higher rate of side effects and adverse events, with no significant difference in hospital stay length.

Conclusions:

  • Direct visual paravertebral block (PVB) is an effective and safe analgesic technique for pediatric patients with CLMs undergoing thoracoscopic surgery.
  • PVB offers superior postoperative pain control, reducing rebound pain and associated adverse events compared to LAI.
  • PVB represents a promising alternative to LAI for pain management in pediatric thoracoscopic procedures.

Keywords:
congenital cystic adenomatoid malformation of lunglocal anesthesianerve blockspostoperative painthoracoscopic surgery

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