Comparative study of ultrasound-guided paravertebral block with ropivacaine versus bupivacaine for post-operative pain relief in children undergoing thoracotomy for patent ductus arteriosus ligation surgery

Abstract

Background and Aims:Thoracotomy incision following patent ductus arteriosus (PDA) ligation surgery is often associated with severe post-operative pain that has deleterious effects on respiratory function. We aimed to assess pain relief with thoracic paravertebral block using either bupivacaine or ropivacaine in these surgeries.Methods:One hundred paediatric patients of age group between 2 and 10 years undergoing PDA ligation surgery were randomised either to bupivacaine or ropivacaine group in this prospective double-blinded study. After induction of general anaesthesia, the ultrasound-guided paravertebral block was carried out using 0.25% bupivacaine 0.4 ml/kg in Group B patients and 0.2% ropivacaine 0.4 ml/kg in Group R patients. Monitoring included minimum mandatory monitoring with pulse rate, pulseoximetry (SpO2), electrocardiogram, blood pressure, temperature during surgery and also in Intensive Care Unit (ICU). Additionally, modified objective pain score (MOPS) was used in ICU for assessment of pain for 12 h after surgery. Incidence of complications was noted.Results:Mean values of MOPSs were comparable in both the groups. The time to rescue analgesic was 8 to 10 h in over 80% of patients in both the groups. More patients had hypotension and bradycardia in bupivacaine group compared to ropivacaine group.Conclusion:Paravertebral injection of 0.4 ml/kg of either 0.2% ropivacaine or 0.25% bupivacaine provided equipotent analgesia, but ropivacaine had a better side effect profile. Ultrasound-guided paravertebral block is a safe and effective mode of analgesia in paediatric patients undergoing thoracotomy.

A comparison of the analgesic efficacy of serratus anterior plane block vs. paravertebral nerve block for video-assisted thoracic surgery: a randomized controlled trial.

“…PVB significantly decreased intraoperative consumption of opioids compared to DSPB and SSPB, which indicated that the short-term analgesic effect of PVB was better than that of DSPB and SSPB. These findings support observations from previous reports that showed the effectiveness of PVB [24].…”

A Comparison of the Analgesic Efficacy of Serratus Anterior Plane Block Vs Paravertebral Nerve Block for Video-assisted Thoracic Surgery: a Randomized Controlled Trial

“…PVB signi cantly decreased intraoperative consumption of opioids comparing to DSPB and SSPB, which indicated the short-term analgesic effect of PVB was better than that of DSPB and SSPB. These ndings support observations from previous reports that showed the effectiveness of PVB (24).…”

Practice advisory on the bleeding risks for peripheral nerve and interfascial plane blockade: evidence review and expert consensus

“…Inadvertent vascular puncture in particular has been reported in 13 publications. [98][99][100][101][102][103][104][105][106][107][108][109][110] These were reported across a range of adult and pediatric populations, under anatomic and ultrasound guidance, during single shot and catheter blocks, and with rates in these reports of between one-in-527 102 and one-in-eight. 105 None of these cases resulted in serious bleeding outcomes, despite the presence of therapeutic anticoagulation in two reports.…”