Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard School of Medicine, Boston, MA, USA.
Department of Surgery, Boston Children's Hospital, Harvard School of Medicine, Boston, MA, USA.
Paediatr Anaesth. 2020 Oct;30(10):1102-1108. doi: 10.1111/pan.13996. Epub 2020 Sep 6.
Mechanical pleurodesis can prevent recurrence of spontaneous pneumothorax but is associated with significant postoperative pain. Adequate pain control is not only beneficial for patient comfort but also critical for mobilization and pulmonary recovery. Thoracic epidural catheters and paravertebral blocks have been used to alleviate pain after thoracoscopic surgery. However, no studies have evaluated the safety and efficacy of paravertebral block vs epidural analgesia vs no block in children undergoing pleurodesis.
In this retrospective case series review, data were extracted from a single institution's integrated patient outcome database on children who underwent thoracoscopic pleurodesis from 2013 to 2018. Demographics, operative indication, procedure performed, and perioperative pain management were assessed by chart review. Patients whose operation was converted to thoracotomy, who had an underlying diagnosis of chronic pain, or who underwent pleurodesis for other indications were excluded. The primary outcomes were postoperative pain scores and opioid consumption. Secondary outcomes included psot anesthesia care unit length of stay, hospital length of stay, functional outcomes during recovery, and any adverse events.
66 patients met inclusion criteria: 23 received thoracic epidurals, 34 received paravertebral blocks, and 9 received no epidural/paravertebral block. Patient characteristics did not significantly differ among groups. Although mean pain scores were statistically significantly lower in the epidural group on post-op day 1, all three groups' pain scores were in the 1 to 3 out of 10 range during the entire postoperative period. Thus, this statistical significance had little clinical significance as all groups had good pain control. The epidural group had significantly lower opioid consumption on post-op days 0 - 2 compared to paravertebral block. No adverse events related to epidural or paravertebral block were noted.
We present the an analysis of epidural vs paravertebral block (with comparison to no regional analgesia) following pleurodesis in children. Pain is well managed, regardless of the method; however, additional systemic opioid consumption was decreased in the epidural analgesia cohort. Prospective trials and comparisons with other analgesic techniques for pediatric thoracic surgeries are needed.
Thoracic epidural analgesia offers a reduction in opioid use in the first two post-op days after pleurodesis but did not produce a clinically significant reduction in pain scores in comparison with paravertebral block or no block.
机械性胸膜固定术可预防自发性气胸复发，但与术后明显疼痛有关。充分的疼痛控制不仅有利于患者的舒适度，而且对活动和肺功能恢复至关重要。胸腔内硬膜外导管和椎旁阻滞已用于减轻胸腔镜手术后的疼痛。然而，尚无研究评估椎旁阻滞与硬膜外镇痛相比或与无阻滞在接受胸膜固定术的儿童中的安全性和疗效。
在这项回顾性病例系列研究中，从 2013 年至 2018 年，从一家机构的综合患者结果数据库中提取了接受胸腔镜胸膜固定术的儿童的数据。通过病历回顾评估人口统计学、手术指征、手术过程和围手术期疼痛管理。排除手术转为开胸手术、有慢性疼痛基础诊断或因其他指征接受胸膜固定术的患者。主要结局是术后疼痛评分和阿片类药物消耗。次要结局包括麻醉后护理病房住院时间、住院时间、恢复期间的功能结果以及任何不良事件。
66 例患者符合纳入标准：23 例接受胸腔内硬膜外麻醉，34 例接受椎旁阻滞，9 例未接受硬膜外/椎旁阻滞。各组患者的特征无显著差异。尽管硬膜外组在术后第 1 天的平均疼痛评分具有统计学意义，但在整个术后期间，三组的疼痛评分均在 1 至 3 分（满分 10 分）范围内。因此，由于所有组都有良好的疼痛控制，这种统计学意义的临床意义不大。与椎旁阻滞相比，硬膜外组在术后 0-2 天的阿片类药物消耗明显减少。未发现与硬膜外或椎旁阻滞相关的不良事件。
我们介绍了一项在儿童胸膜固定术后硬膜外与椎旁阻滞（与无区域镇痛相比）的分析。无论采用何种方法，疼痛均得到良好控制；然而，硬膜外镇痛组的阿片类药物总消耗减少。需要进行前瞻性试验，并与其他小儿胸腔手术的镇痛技术进行比较。
胸腔内硬膜外镇痛可减少胸膜固定术后前 2 天的阿片类药物使用，但与椎旁阻滞或无阻滞相比，疼痛评分无明显降低。
