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A Prospective Randomized Observer-Blinded Study to Assess Postoperative Analgesia Provided by an Ultrasound-Guided Bilateral Thoracic Paravertebral Block for Children Undergoing the Nuss Procedure

Qi, Jiashan MD*; Du, Bin MD*; Gurnaney, Harshad MBBS, MPH; Lu, Peilin MD*; Zuo, Yunxia PhD, MD*

Regional Anesthesia and Pain Medicine: May/June 2014 - Volume 39 - Issue 3 - p 208–213
doi: 10.1097/AAP.0000000000000071
Original Articles

Background and Objectives This prospective, randomized, single-blinded study evaluates the effectiveness of the ultrasound-guided bilateral thoracic paravertebral (BTPV) block for providing postoperative pain control in children undergoing the Nuss procedure.

Methods Thirty American Society of Anesthesiologists I–II children with pectus excavatum, scheduled for the Nuss procedure, were enrolled at West China Hospital of Sichuan University. The patients were randomly allocated into the BTPV block group or the control group. In the BTPV group, 0.25% ropivacaine 0.5 mL/kg with 1:200,000 epinephrine was injected under ultrasound guidance on each side at the level of the fifth thoracic vertebra. Postoperative pain was evaluated in both groups for the first 48 hours. Total opioid administered and cumulative attempts on the patient/parent-controlled intravenous analgesia (PCA) pump were recorded. Postoperative negative behavioral changes in the children were evaluated on postoperative days 1, 7, and 30, respectively, using the posthospital behavior questionnaire.

Results The pain scores were significantly reduced in the postanesthesia care unit and for the first 48 hours postoperatively in the BTPV group compared to the control group (P < 0.01). The sufentanil use in the postanesthesia care unit was significantly greater in the control group [mean (SD), 0.2 (0) mcg/kg] compared to the BTPV group [mean (SD), 0.05 (0.06) mcg/kg] (P < 0.01). The postoperative sufentanil use was significantly higher in the control group during the first 24 hours (P < 0.01). Numbers of attempts on the PCA pump were significantly greater in the control group (P < 0.01). The posthospital behavior questionnaire score was lower in the BTPV group on day 1, day 7, and 1 month, respectively (P < 0.01).

Conclusions Ultrasound-guided BTPV block provides improved postoperative analgesia for children undergoing the Nuss procedure as compared with intravenous PCA and decreases the incidence of postoperative behavioral disturbance.

Supplemental digital content is available in the text.

From the *Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China; and †Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA.

Accepted for publication February 3, 2014.

Address correspondence to: Bin Du, MD, Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China (e-mail: phoenixdb2008huaxi@gmail.com).

The authors declare no conflict of interest.

Jiashan Qi and Bin Du contributed equally to this work.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.rapm.org).

Copyright © 2014 by American Society of Regional Anesthesia and Pain Medicine.