Paravertebral analgesia versus wound infiltration in children recovering from cardiac surgery: a randomized...

Area of Science:

• Pediatric Anesthesiology
• Thoracic Surgery Pain Management
• Regional Anesthesia

Background:

• Optimal postoperative analgesia after thoracotomies, particularly in pediatric cardiac surgery, remains an area of investigation.
• Paravertebral blocks offer a potentially more effective, though complex, alternative to local anesthetic infiltration for pain control.

Purpose of the Study:

• To compare the efficacy of paravertebral blocks versus local anesthetic wound infiltration for postoperative analgesia in children undergoing cardiac surgery via thoracotomy.

Main Methods:

• A single-center, randomized, double-blind trial involving 100 children (aged 6-14 years) with septal defects undergoing cardiac surgery.
• Patients were randomized to receive either paravertebral blocks or local anesthetic wound infiltration post-surgery.
• Primary outcomes included 24-hour opioid consumption and pain scores; secondary outcomes included complications like nausea, vomiting, and respiratory failure.

Main Results:

• Patients receiving paravertebral blocks had significantly lower 24-hour sufentanil consumption (0.3±0.4 µg/kg) compared to wound infiltration (0.6±0.5 µg/kg; p=0.002).
• Pain scores (Faces Pain Scale-Revised) were consistently lower in the paravertebral block group at all measured time points, with the greatest difference at 6 hours postoperatively (p<0.001).
• There were no significant differences in mechanical ventilation time, ICU stay, hospitalization duration, or incidence of postoperative nausea and vomiting between the groups.

Conclusions:

• Paravertebral blocks effectively reduce opioid requirements and improve pain control in the first 24 hours after pediatric cardiac thoracotomies.
• While beneficial for pain and opioid reduction, paravertebral blocks did not demonstrate an acceleration of patient recovery in terms of ventilation, ICU, or hospital stay.