Comparison of regional vs. systemic analgesia for post-thoracotomy care in infants.
BACKGROUND
In infants, post-thoracotomy analgesia traditionally consists of systemic opiates, while regional techniques have gained more favor in recent years. We compare the two techniques for thoracotomy in infants.


METHODS
All consecutive patients below 6 months of age who underwent thoracotomy for congenital pulmonary malformations in the study period were retrospectively divided according to the chosen postoperative analgesia: Group S systemic opiates, Group R continuous regional (epidural or extrapleural paravertebral) block. We studied the following outcomes: need for NICU and mechanical ventilation, pain score, requirement for additional analgesics, heart rate 1 h postsurgery, time to pass first stool and to full feed, complications, and duration of hospitalization.


RESULTS
Forty consecutive patients were included, 19 in Group S and 21 in Group R. Median age at surgery was 89 days (40-110) and 90 days (46-117), respectively. Five of 19 patients in Group S vs none in Group R required postoperative intensive care (P = 0.017). Patients in Group R had significantly lower postoperative heart rate (145 [138-150] vs. 160 [152-169] b·min(-1) , P = 0.007), earlier passage of first stools (24 h [12-24] vs. 36 h [24-48] P = 0.004), and earlier time to full feed (36 h [24-48] vs. 84 h [60-120] P = 0.0001) than those in Group S. The only observed complication was one catheter dislocation.


CONCLUSIONS
In infants undergoing thoracotomy, loco-regional analgesia is effective and associated with a reduced intensity of postoperative care and earlier full feeding than systemic analgesia; it should therefore be considered a better option.
Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Alessandra
A
Di Pede
Francesco
F
Morini
Mary H
MH
Lombardi
Stefania
S
Sgrò
Raoul
R
Laviani
Andrea
A
Dotta
Sergio G
SG
Picardo
D000698:Analgesia / Q000379:methods*; D015360:Analgesia, Epidural; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008168:Lung / Q000002:abnormalities / Q000601:surgery; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009407:Nerve Block; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies; D013908:Thoracotomy; D016896:Treatment Outcome
D000700:Analgesics; D000701:Analgesics, Opioid; D009020:Morphine
analgesia; anesthetic techniques; epidural; infant; newborn; postoperative care; regional; thoracic; thoracotomy