Single injection paravertebral block for renal surgery in children.
BACKGROUND
Continuous paravertebral block (PVB) has been successfully used for postoperative analgesia in children. However, data regarding the efficacy of a single injection technique for major renal surgery are still lacking.


METHODS
Following the ethics committee approval and parent informed consent, 24 children (median 10.3 months; range: 2.9-26.8) undergoing major renal surgery were included in a prospective observational pilot study. Following a standardized general anesthetic the patients were administered a single injection low thoracic PVB (loss-of-resistance technique; 0.5 ml.kg(-1) of levobupivacaine 2.5 mg.ml(-1) with epinephrine 5 mug.ml(-1)) at the end of surgery. Postoperative pain was assessed by Face, Legs, Activity, Cry, Consolability (FLACC) score at predetermined time points and in case of apparent patients' discomfort during the first 12 postoperative hours. The duration of postoperative analgesia was defined as the interval between PVB and the first supplemental administration of a rescue opioid analgesic. The incidence of complications and postoperative vomiting (POV) was also recorded.


RESULTS
A successful PVB was achieved in 23/24 patients (95.8%). The median duration of the block was 600 min (range: 180-720 min) with 10 children not requiring any supplemental analgesia during the 12-h observation period. Vascular puncture was observed in 2/24 children (8.3%) and POV occurred in 4/24 children (16.7%). All complications were considered minor and did not influence recovery.


CONCLUSIONS
Single injection PVB provided clinically relevant postoperative analgesia in children undergoing major renal surgery.
Berta
Emil
E
Department of Anaesthesia and Intensive Care, University Hospital Olomouc, Olomouc, Czech Republic. e.berta@email.cz
Spanhel
Jiri
J
Smakal
Oldrich
O
Smolka
Vratislav
V
Gabrhelik
Tomas
T
Lönnqvist
Per-Arne
PA
D000322:Adrenergic Agonists / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D002675:Child, Preschool; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007223:Infant; D007278:Injections, Spinal; D007668:Kidney / Q000601:surgery*; D000077554:Levobupivacaine; D008297:Male; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement / Q000379:methods / Q000706:statistics & numerical data; D010149:Postoperative Pain / Q000188:drug therapy*; D010865:Pilot Projects; D011446:Prospective Studies; D013904:Thoracic Vertebrae / Q000294:innervation; D013997:Time Factors; D016896:Treatment Outcome
D000322:Adrenergic Agonists; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine; D004837:Epinephrine