Continous retropleural infusion for analgesia after thoracotomy in newborn infants

Autor: Vane, Dennis W., Pietropaoli, John A., Smail, F. David, Hong, Andrew R., Abajian, J. Christian
Zdroj: Pediatric Surgery International; July 1995, Vol. 10 Issue: 5-6 p311-314, 4p
Abstrakt: Postoperative pain control in neonates is a difficult management problem. The utilization of narcotics, while effective, is often a titration problem resulting in respiratory complications, may cause gastrointestinal bleeding or give inconsistent relief, frequently requiring the addition of a sedative. Regional pain relief techniques such as epidural catheters have been extremely effective in newborns but have not been widely utilized after thoracotomy because of fears of respiratory embarrassment from diaphragmatic effects. We have used continous infusion retropleural regional anesthetic agents in ten newborns undergoing repair of tracheoesophageal fistula and esophageal atresia. The technique involves placing a 20-gauge epidural catheter (Portex) through an 18-gauge transthoracic needle (Tuohy-Schliff) above the thoracotomy incision under direct vision of the surgeon. The catheter is sutured in place with a single 6-0 plain gut suture so that the egress port of the catheter is slightly cephalad and ventral to the entered intercostal space. Closure of the chest is performed in standard fashion and the retropleural space was drained with a chest tube on 5 cm H2O suction. 1/16% bupivicaine was infused at 1.6 cc/h for analgesia. All patients were extubated in the recovery room and taken directly to the neonatal ICU. Analgesia was excellent for all infants and none required supplemental pain control for their surgical procedures. This is the first description of pleural-based anesthesia for postoperative pain control in neonates. The technique provides excellent pain control for thoracotomies in these infants and does not interfere with respiratory effort. Analgesia appears to be local and somatic and diaphragmatic function is preserved. Other anatomic areas are not affected as the analgesic phenomena is localized to the operative site. The respiratory problems associated with systemic administration of potent analgesics are avoided.
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