title: Anesthesia management with single injection paravertebral block for aorta coarctation in infant.
abstract: BACKGROUND
  Thoracotomy causes severe pain in the postoperative period. Perioperative thoracic paravertebral block reduces pain score and may improve outcome after pediatric cardiac surgery. This prospective study was designed for the efficacy and duration of a single level, single injection ultrasound-guided thoracic paravertebral block (TPVB) for fifteen infants undergoing aortic coarctation repair.
  
  
  METHODS
  After approval of the ethical committee and the relatives of the patients, 15 infants who had undergone thoracotomy were enrolled in the study. The patients received 0.5 ml·kg(-1) a bolus 0.25% bupivacaine with epinephrine 1 : 200 000 at T5-6 level after standard general anesthesia induction. Anesthesia depth with Index of Consciousness (IOC) and tissue oxygen saturation with cerebral (rSO2-C) and somatic thoracodorsal (rSO2-S) were monitored. Intraoperative hemodynamic and postoperative hemodynamic and pain scores were evaluated for 24 h after surgery. Face, Legs, Activity, Cry, Consolability (FLACC) score was utilized to measure postoperative pain in the intensive care unit. Rescue 0.05 mg·kg(-1) IV morphine was applied to patients in whom FLACC was >3.
  
  
  RESULTS
  The median age of the patients was 4.5 (1-11) months, and the median intraoperative endtidal isoflurane concentration was 0.6% (0.3-0.8). The amount of remifentanil used intraoperatively was 4.5 (2.5-14) μg·kg(-) (1) ·h(-1). Intraoperative heart rate and blood pressure values significantly decreased compared with values detected at 5th, 10th, and 15th min after TPVB application, after incision prior and after cross-clamp (P < 0.01). The median time of first dose of morphine application after block was 320 (185-430) min. The median morphine consumption in 24 h was 0.16 (0.09-0.4) mg·kg(-1). The median length of postoperative intensive care unit and in-hospital stay times was 23 (1-67) h and 4 (1-10) days, respectively.
  
  
  CONCLUSIONS
  We believe that TPVB, as part of a balanced anesthetic and analgesic regime, provides effective pain relief in patients undergoing aortic coarctation repair.
authors: Department of Anesthesiology, Baskent University Istanbul Training and Medical Research Center, Istanbul, Turkey.
authors: Ayda
authors: A
authors: Türköz
authors: Sule T
authors: ST
authors: Balcı
authors: Meltem
authors: M
authors: Can Güner
authors: Halim
authors: H
authors: Ulugöl
authors: Can
authors: C
authors: Vuran
authors: Emre
authors: E
authors: Özker
authors: Rıza
authors: R
authors: Türköz
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use; D000775:Anesthesia, Spinal / Q000379:methods*; D018686:Anesthetics, Intravenous; D001017:Aortic Coarctation / Q000601:surgery*; D001794:Blood Pressure / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007223:Infant; D008297:Male; D016343:Monitoring, Intraoperative; D009020:Morphine / Q000627:therapeutic use; D010100:Oxygen / Q000097:blood; D010149:Postoperative Pain / Q000188:drug therapy; D010880:Piperidines; D011229:Preanesthetic Medication; D011446:Prospective Studies; D000077208:Remifentanil; D018084:Ultrasonography, Interventional
chemical_list: D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D010880:Piperidines; D009020:Morphine; D000077208:Remifentanil; D010100:Oxygen
keywords: aortic coarctation repair; infant; paravertebral block