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Postoperative analgesia following thoracotomy in children: interpleural catheters
J D Tobias1, L D Martin, L Oakes
1Department of Anesthesiology, Vanderbilt University, Nashville, TN 37232-2591.
Insights
Interpleural analgesia (IPA) effectively managed postoperative pain in 13 of 14 children after thoracotomy. This technique provided adequate pain relief with minimal need for additional analgesics, showing good safety in pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Thoracic Surgery
Background:
- Postoperative pain control is crucial for pediatric surgical recovery.
- Interpleural analgesia (IPA) is a newer method for managing surgical pain.
Purpose of the Study:
- To evaluate the efficacy and safety of interpleural analgesia (IPA) in children undergoing thoracotomy.
Main Methods:
- Retrospective review of 14 pediatric patients who received IPA post-thoracotomy.
- Analysis of pain management via subjective and objective measures.
- Assessment of additional analgesic requirements and complications.
Main Results:
- 13 out of 14 patients achieved adequate analgesia with IPA.
- Eight patients required no additional pain medication.
- No IPA-related complications were observed.
Conclusions:
- Interpleural analgesia (IPA) is an effective and safe method for postoperative pain management in children following thoracotomy.
- IPA can significantly reduce the need for supplementary analgesics.
Abstract:
The authors retrospectively review their experience in children with the latest addition to the postoperative analgesic armamentarium: interpleural analgesia (IPA). IPA was used in 14 children following thoracotomy. There were 9 boys and 5 girls. Patients varied in age from 2 months to 17 years 4 months (mean +/- SEM = 7.6 +/- 1.6 yr). Catheters were left in place from 10 to 72 hours (mean +/- SEM = 45.1 +/- 4.6 h). Four patients received intermittent bolus doses and 10 patients received a continuous infusion through the interpleural catheters. Adequate analgesia, as judged by both subjective responses (decreased irritability or complaints of pain) and by objective physiologic responses (decreased heart rate, respiratory rate, and systolic blood pressure), was achieved in 13 of 14 patients. Eight of the 14 children required no additional analgesic agents. One child received 2 doses of oral codeine and 4 patients received 2 to 3 doses of intravenous narcotic during IPA. IPA was not effective in one patient who required 6 doses of intravenous meperidine. Patients more than 10 years of age required significantly more (P < 0.05) intravenous narcotic supplementation than patients less than 10 years of age (1.60 +/- 0.50 v 0.14 +/- 0.11 mg meperidine/kg/d). No complications related to placement or subsequent use of IPA were identified in any of the patients. IPA provides effective postoperative analgesia following thoracotomy in children.