Paravertebral regional blocks decrease length of stay following surgery for pectus excavatum in children
| Autor: | Patrick D. Loftus, Michael D. Rollins, David E. Skarda, Stephen P Spanos, Katie W. Russell, Douglas C. Barnhart, Craig T. Elder, Rebecka L. Meyers, Eric R. Scaife |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Catheters Narcotic Continuous infusion medicine.medical_treatment Benzodiazepines 03 medical and health sciences 0302 clinical medicine Thoracic epidural Pectus excavatum 030225 pediatrics medicine Humans Child Infusions Intravenous Retrospective Studies Surgical repair Analgesics Pain Postoperative business.industry Nerve Block Retrospective cohort study General Medicine Length of Stay Pain management medicine.disease Surgery Analgesia Epidural Analgesics Opioid Funnel Chest 030220 oncology & carcinogenesis Anesthesia Pediatrics Perinatology and Child Health Nerve block business |
| Zdroj: | Journal of Pediatric Surgery. 51:149-153 |
| ISSN: | 0022-3468 |
| DOI: | 10.1016/j.jpedsurg.2015.10.037 |
| Popis: | Management of postoperative pain following repair of pectus excavatum has traditionally included thoracic epidural analgesia, narcotics, and benzodiazepines. We hypothesized that the use of intercostal or paravertebral regional blocks could result in decreased inpatient length of stay (LOS).We conducted a retrospective cohort study of 137 patients (118 Nuss and 19 Ravitch - Nuss and Ravitch patients were analyzed separately) who underwent surgical repair of pectus excavatum with pain management via epidural, intercostal, or paravertebral analgesia from January 2009-December 2012. Measured outcomes included LOS, pain scores, benzodiazepine/narcotic requirements, emesis, professional fees, hospital cost, and total cost.In the Nuss patients, LOS was significantly reduced in the paravertebral group (p0.005) and the intercostal group (p0.005) compared to the epidural group, but was paradoxically countered by a nonsignificant increase in total cost (p=0.09). While benzodiazepine doses/day was not increased in the paravertebral group (p=0.08), an increase was seen in narcotic use (p0.005). Despite increased narcotic use, no differences were seen in emesis between epidural and paravertebral use. Compared to epidural, pain scores were higher for both intercostal and paravertebral on day one (p0.005), but equivalent for paravertebral on day three (p=0.62). The Ravitch group was too small for detailed independent statistical analysis but followed the same overall trend seen in the Nuss patients.Our use of paravertebral continuous infusion pain catheters for pectus excavatum repair was an effective alternative to epidural analgesia resulting in shorter LOS but not a decrease in overall cost. |
| Databáze: | OpenAIRE |
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