Visoiu Mihaela, Sadhasivam Senthilkumar
Department of Anaesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
Children (Basel). 2023 Jan 20;10(2):193. doi: 10.3390/children10020193.
The continuous paravertebral blockade as part of the multimodal pain protocol is an effective regional technique to control pain after the Nuss procedure. We investigated the effectiveness of clonidine as an adjunct to paravertebral ropivacaine infusion.
We conducted a retrospective study of 63 patients who underwent Nuss procedures and received bilateral paravertebral catheters. Data on demographics, surgical, anesthesia, and block characteristics, numeric rating pain scores (NRS), opioids consumption, hospital length of stay, complications, and side effects from medication administration were collected in children who received paravertebral ropivacaine 0.2% infusion without (N = 45) and with clonidine (1 mcg/mL) (N = 18).
The two groups had similar demographics, although the clonidine group had higher Haller indices (6.5 (4.8, 9.4) vs. 4.8 (4.1, 6.6), = 0.013). The clonidine group required less morphine equivalent/kg on postoperative day 2 (median, interquartile range 0.24 (0.22, 0.31) vs. 0.47 (0.29, 0.61) = 0.002). There was no difference in median NRS pain scores. Both groups had similar catheter infusion durations, hospital length of stay, and complication rates.
A postoperative pain management plan that includes paravertebral analgesia, including clonidine as an adjunct, may be considered to minimize opioid administration for patients undergoing primary Nuss repair.
作为多模式疼痛方案一部分的连续椎旁阻滞是控制努氏手术后疼痛的一种有效区域技术。我们研究了可乐定作为椎旁罗哌卡因输注辅助药物的有效性。
我们对63例行努氏手术并接受双侧椎旁导管置入的患者进行了一项回顾性研究。收集了接受0.2%罗哌卡因椎旁输注（无可乐定组，N = 45）和含可乐定（1 mcg/mL）椎旁输注（N = 18）的儿童患者的人口统计学、手术、麻醉和阻滞特征、数字疼痛评分（NRS）、阿片类药物消耗量、住院时间、并发症及药物给药副作用等数据。
两组患者的人口统计学特征相似，尽管可乐定组的哈勒指数较高（6.5（4.8，9.4）对4.8（4.1，6.6），P = 0.013）。可乐定组术后第2天每千克体重所需吗啡当量较少（中位数，四分位数间距0.24（0.22，0.31）对0.47（0.29，0.61），P = 0.002）。NRS疼痛评分中位数无差异。两组的导管输注持续时间、住院时间和并发症发生率相似。
对于接受初次努氏修复手术的患者，可考虑采用包括椎旁镇痛（含可乐定作为辅助药物）的术后疼痛管理方案，以尽量减少阿片类药物的使用。
