title: [Thoracic epidural analgesia in the postoperative period of pediatric surgery for the repair of pectus excavatum and pectus carinatum].
abstract: To assess thoracic analgesia by continuous infusion in surgery to repair pectus excavatum and carinatum in children. This prospective study enrolled 14 children aged 6 to 14 years old scheduled for surgery to correct pectus excavatum and carinatum. After induction of general anesthesia, the T8-T9 epidural space was accessed and a catheter was inserted to T3-T7 with radioscopic monitoring. A loading dose of 0.03-0.04 ml/kg per segment to be blocked (5 segments: T3-T8) of 0.125% bupivacaine and 3 micrograms/ml fentanyl was given to children under 7 years of age; a dose of 0.02-0.03 ml/kg per segment was administered to children over the age of 7 years. A continuous perfusion of 0.1-0.4 ml/kg/h was maintained, with the possibility of additional boluses of 1 ml at 20 min intervals during surgery and the first three days thereafter. An intraoperative bolus was given when the level of blockade was not reached or when mean blood pressure and heart rate increased 15% over baseline. Pain relief was assessed on a numerical scale of 0 to 5 or on a scale of facial icons, depending on the patient's age. During the postoperative period, the pediatric ICU nurse administered a bolus if pain was [symbol see text]3 or heart rate increased 75% over age-based reference values. Top-up analgesia was provided with Metamizole at a dose of 25 mg/kg. No complications attributable to the technique or to sympathetic blockade were observed. All tubes were removed in the operating room. The thoracic epidural catheter was left in place for 70.3 +/- 2.6 h. Mean initial doses of analgesia were 0.45 microgram/kg of fentanyl and 0.2 mg/kg of bupivacaine. The mean number of complementary boluses was 3 +/- 1 during surgery, 5 +/- 2 on the first postoperative day and 4 +/- 1 on the second day. No patient required top-up analgesia on the third day. Hemodynamic stability during surgery and the postoperative period was good. Analgesia was excellent (< 2) for 78.5% of the patients on the first day after surgery, for 85.7% on the second day and for all patients on the third day. We recorded one case of pruritus (7.1%), three of nausea (21.4%) that subsided when butorphanol was given epidurally (20 micrograms/kg), and two cases of light sedation. Thoracic epidural analgesia is effective for alleviating postoperative pain from corrective thoracic surgery in children. Side effects were minimal and no anesthetic complications were observed.
authors.affiliation: Servicio de Anestesiología, Reanimación y Dolor, Hospital Cristal-Piñor, Orense.
authors.forename: L
authors.initials: L
authors.lastname: Cánovas Martínez
authors.forename: M
authors.initials: M
authors.lastname: Domínguez García
authors.forename: N
authors.initials: N
authors.lastname: Fernández Gil
authors.forename: A
authors.initials: A
authors.lastname: Montes Deza
authors.forename: D
authors.initials: D
authors.lastname: López Alonso
authors.forename: A
authors.initials: A
authors.lastname: Castro Méndez
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D000293:Adolescent; D015360:Analgesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D002648:Child; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011182:Postoperative Care; D011446:Prospective Studies
chemical_list: D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine
vernacular_title: Analgesia epidural torácica en el postoperatorio de la cirugía pediátrica reparadora del pectus excavatum y del pectus carinatum.