Freedman Zachary, AuBuchon Jacob, Montana Michael
Penn State College of Medicine Hershey Pennsylvania USA.
Department of Anesthesiology Washington University in St. Louis and St. Louis Children's Hospital St. Louis Missouri USA.
Paediatr Neonatal Pain. 2022 Dec 7;5(1):16-22. doi: 10.1002/pne2.12092. eCollection 2023 Mar.
Regional anesthesia between the pectoralis major and minor was first described in 2011 as an alternative method to paravertebral blocks or epidurals for post-operative mastectomies. Since then, the use of pectoral nerve (PECS) blocks for post-operative pain management following thoracotomy, sternotomy, and other procedures in the anterior thorax has increased. While experience with this block is growing, the current understanding of its use in pediatric patients is limited. We reviewed pediatric cases at a single institution and provide a descriptive account of our use of PECS I and II blocks for post-operative pain management following operations involving sternotomy in pediatric patients. We performed a retrospective database analysis of the use of PECS I and II blocks following procedures requiring sternotomy from 2018 to 2021 at St. Louis Children's Hospital. Patients 21 years old and younger who received either a PECS I or II block following a sternotomy for a cardiac procedure were included in the analysis. Patient's demographics, pre-, intra-, and post-operative medications, operative time, extubation status, pain evaluations, and hospital course were assessed from the electronic medical record. From 2018 to 2021, 73 ultrasound-guided PECS blocks were performed for pain relief for pediatric sternotomy. The most commonly performed operations were atrial septal defect closure ( = 12), mitral valve repair ( = 8), and ventricle septal defect closure ( = 8). Out of the 73 patients, 47 received a PECS I block and 26 received a PECS II Block. 70 of the blocks were administered after closure of the sternum while 3 were done before incision. The time to perform blocks took on average of 6 (±4) min. Mean operating room time was 7.5 h. Local anesthetics used for the blocks were as follows: Ropivacaine 0.2% ( = 54), Ropivacaine 0.5% ( = 18), and Bupivacaine 0.25% ( = 1). Twenty-five out of 73 patients did not experience severe pain, defined as ≥7/10 on a numeric pain scale, at any point in the first 24 h following surgery. We describe the of use PECS I and II nerve block following pediatric sternotomy. Blocks were straight forward to perform, and typically took a short amount of time to administer (6 min), when compared to the total operating room time (7.5 h). While this study did not include a comparative group that did not receive a block, 34 percent of patients did not suffer from severe pain in the first 24 h following surgery. Further prospective studies are needed to assess the effectiveness of PECS blocks for pain relief following sternotomy in pediatric patients when compared to current standard of care. PECS blocks may be beneficial for a range of cardiac surgeries that typically result in severe postoperative pain.
2011年，首次描述了胸大肌和胸小肌之间的区域麻醉，作为术后乳房切除术替代椎旁阻滞或硬膜外阻滞的一种方法。从那时起，胸段神经（PECS）阻滞在开胸手术、胸骨切开术和前胸其他手术术后疼痛管理中的应用有所增加。虽然对这种阻滞的经验在不断积累，但目前对其在儿科患者中的应用了解有限。我们回顾了单一机构的儿科病例，并描述了我们在儿科患者胸骨切开术后使用PECS I和II阻滞进行术后疼痛管理的情况。我们对2018年至2021年在圣路易斯儿童医院进行胸骨切开术的患者使用PECS I和II阻滞的情况进行了回顾性数据库分析。分析纳入了21岁及以下在心脏手术胸骨切开术后接受PECS I或II阻滞的患者。从电子病历中评估患者的人口统计学特征、术前、术中和术后用药情况、手术时间、拔管状态、疼痛评估和住院过程。2018年至2021年，共进行了73次超声引导下的PECS阻滞，用于缓解儿科胸骨切开术后的疼痛。最常进行的手术是房间隔缺损修补术（n = 12）、二尖瓣修复术（n = 8）和室间隔缺损修补术（n = 8）。在73例患者中，47例接受了PECS I阻滞，26例接受了PECS II阻滞。70次阻滞在胸骨闭合后进行，3次在切口前进行。进行阻滞的平均时间为6（±4）分钟。平均手术室时间为7.5小时。用于阻滞的局部麻醉药如下：0.2%罗哌卡因（n = 54）、0.5%罗哌卡因（n = 18）和0.25%布比卡因（n = 1）。73例患者中有25例在术后24小时内的任何时间均未经历严重疼痛，严重疼痛定义为数字疼痛量表评分≥7/10。我们描述了儿科胸骨切开术后使用PECS I和II神经阻滞的情况。与总手术室时间（7.5小时）相比，阻滞操作简单，给药时间通常较短（6分钟）。虽然本研究未纳入未接受阻滞的对照组，但34%的患者在术后24小时内未遭受严重疼痛。与当前的护理标准相比，还需要进一步的前瞻性研究来评估PECS阻滞对儿科患者胸骨切开术后疼痛缓解的有效性。PECS阻滞可能对一系列通常导致严重术后疼痛的心脏手术有益。
