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.
Reg Anesth Pain Med. 2014 May-Jun;39(3):208-13. doi: 10.1097/AAP.0000000000000071.
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.
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.
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).
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.
本前瞻性、随机、单盲研究评估了超声引导双侧胸椎旁（BTPV）阻滞在接受 Nuss 手术的儿童中提供术后疼痛控制的效果。
四川大学华西医院纳入了 30 名 ASA 分级 I-II 级的漏斗胸患儿，他们将接受 Nuss 手术。患者被随机分配到 BTPV 阻滞组或对照组。在 BTPV 组中，在超声引导下于第五胸椎水平每侧注射 0.5 mL/kg 0.25%罗哌卡因加 1:200,000 肾上腺素。两组均在术后 48 小时内评估术后疼痛。记录两组患者的总阿片类药物用量和患者/家长自控静脉镇痛（PCA）泵的累计按压次数。分别于术后第 1、7 和 30 天使用住院后行为问卷评估患儿的术后负性行为变化。
与对照组相比，BTPV 组在麻醉后恢复室和术后 48 小时内的疼痛评分显著降低（P<0.01）。对照组（0.2[0]mcg/kg）在麻醉后恢复室使用舒芬太尼的量显著高于 BTPV 组（0.05[0.06]mcg/kg）（P<0.01）。对照组在术后 24 小时内的舒芬太尼使用量显著较高（P<0.01）。对照组 PCA 泵按压次数显著较高（P<0.01）。BTPV 组在术后第 1、7 和 1 个月的住院后行为问卷评分较低（P<0.01）。
与静脉 PCA 相比，超声引导下 BTPV 阻滞可为接受 Nuss 手术的儿童提供更好的术后镇痛，并降低术后行为障碍的发生率。
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