title: Postoperative pain control with paravertebral catheters after pediatric total pancreatectomy and islet autotransplantation: a retrospective cohort study.
abstract: BACKGROUND
  Total pancreatectomy and islet autotransplantation (TPIAT) has been used to treat pediatric patients with chronic pancreatitis. The primary symptom of this disease is extreme poorly controlled pain. This results in significant alterations in the quality of life of the patient. We sought to determine if the addition of bilateral thoracic paravertebral catheters with continuous ropivacaine infusion would improve postoperative opioid use and pain control.
  
  
  METHODS
  The medical records of 32 patients who underwent TPIAT from March 2011 to July 2014 were analyzed retrospectively (15 without paravertebral catheters and 17 with paravertebral catheters). Maximum and minimum pain scores, opioid use (mg · kg(-1) · day(-1)), percent opioid use above baseline, length of stay, and complications were recorded.
  
  
  RESULTS
  Those patients who had bilateral thoracic paravertebral catheters had decreased total opioid use in the first 7 days postoperatively when compared to those who did not (612 (95% CI: 432-792) vs 943.7 (95% CI: 650-1237) mg of morphine equivalents; P = 0.043). The total opioid use remained significantly decreased when corrected for weight (12.53 (95% CI: 9.19-15.44) vs 18.85 (95% CI: 13.69-24.03) mg · kg(-1) of morphine equivalents; P = 0.03). In addition, those on preoperative opioids had less percent opioid use above baseline on postoperative days 1, 2, and 7 as well as decreased opioid use (mg · kg(-1) · day(-1)) on postoperative days 1, 2, 3, and 7. There were no differences in complications or length of stay.
  
  
  CONCLUSIONS
  Bilateral paravertebral catheters may provide decreased opioid use and improved postoperative pain control after TPIAT.
authors.affiliation: Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Hutchins
authors.affiliation: Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Chandra
authors.initials: C
authors.lastname: Castro
authors.affiliation: Biostatistics Design and Analysis Center, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Qi
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Srinath
authors.initials: S
authors.lastname: Chinnakotla
mesh_terms: D000293:Adolescent; D000577:Amides / Q000008:administration & dosage* / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D057785:Catheters; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016381:Islets of Langerhans Transplantation; D008297:Male; D009407:Nerve Block / Q000295:instrumentation* / Q000379:methods; D059408:Pain Management / Q000295:instrumentation / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D010180:Pancreatectomy; D010195:Pancreatitis / Q000601:surgery*; D012189:Retrospective Studies; D000077212:Ropivacaine; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
keywords: acute pain; analgesia; anesthetics local; chronic pain; opioids; ultrasound