Di Pede Alessandra, Morini Francesco, Lombardi Mary H, Sgrò Stefania, Laviani Raoul, Dotta Andrea, Picardo Sergio G
Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Paediatr Anaesth. 2014 Jun;24(6):569-73. doi: 10.1111/pan.12380. Epub 2014 Apr 9.
In infants, post-thoracotomy analgesia traditionally consists of systemic opiates, while regional techniques have gained more favor in recent years. We compare the two techniques for thoracotomy in infants.
All consecutive patients below 6 months of age who underwent thoracotomy for congenital pulmonary malformations in the study period were retrospectively divided according to the chosen postoperative analgesia: Group S systemic opiates, Group R continuous regional (epidural or extrapleural paravertebral) block. We studied the following outcomes: need for NICU and mechanical ventilation, pain score, requirement for additional analgesics, heart rate 1 h postsurgery, time to pass first stool and to full feed, complications, and duration of hospitalization.
Forty consecutive patients were included, 19 in Group S and 21 in Group R. Median age at surgery was 89 days (40-110) and 90 days (46-117), respectively. Five of 19 patients in Group S vs none in Group R required postoperative intensive care (P = 0.017). Patients in Group R had significantly lower postoperative heart rate (145 [138-150] vs. 160 [152-169] b·min(-1) , P = 0.007), earlier passage of first stools (24 h [12-24] vs. 36 h [24-48] P = 0.004), and earlier time to full feed (36 h [24-48] vs. 84 h [60-120] P = 0.0001) than those in Group S. The only observed complication was one catheter dislocation.
In infants undergoing thoracotomy, loco-regional analgesia is effective and associated with a reduced intensity of postoperative care and earlier full feeding than systemic analgesia; it should therefore be considered a better option.
在婴儿中，传统的开胸术后镇痛方法是使用全身性阿片类药物，而近年来区域技术更受青睐。我们比较这两种婴儿开胸术的镇痛技术。
回顾性分析研究期间所有6个月以下因先天性肺畸形接受开胸手术的连续患者，根据所选的术后镇痛方法进行分组：S组为全身性阿片类药物，R组为连续区域（硬膜外或胸膜外椎旁）阻滞。我们研究了以下结果：入住新生儿重症监护病房（NICU）和机械通气的需求、疼痛评分、额外镇痛药的需求、术后1小时心率、首次排便时间和完全喂养时间、并发症以及住院时间。
纳入40例连续患者，S组19例，R组21例。手术时的中位年龄分别为89天（40 - 110天）和90天（46 - 117天）。S组19例患者中有5例需要术后重症监护，而R组无此情况（P = 0.017）。R组患者术后心率显著较低（145[138 - 150]次/分钟对160[152 - 169]次/分钟，P = 0.007），首次排便时间更早（24小时[12 - 24小时]对36小时[24 - 48小时]，P = 0.004），完全喂养时间也更早（36小时[24 - 48小时]对84小时[60 - 120小时]，P = 0.0001）。唯一观察到的并发症是1例导管移位。
在接受开胸手术的婴儿中，局部区域镇痛有效，与全身镇痛相比，术后护理强度降低且完全喂养时间更早；因此应被视为更好的选择。
