Paravertebral versus single shot epidural blockade for neonates undergoing thoracotomy

Abstract

Background and Aims: Postthoracotomy pain in neonates has negative physiological consequences include impaired ventilation and vasoconstriction of both systemic and pulmonary vascular beds leading to compromised organ function. This study aimed to compare the effect of paravertebral blockade to single shot epidural blockade on postthoracotomy pain control. Methods: A prospective study was conducted in El Shatby University Hospital, from April 2018 to March 2020 where forty neonates scheduled for a trachea-esophageal fistula (TOF) repair via thoracotomy were randomized to Group A (thoracic epidural single injection with 0.5 ml/ kg of 0.25% of L-Bupivacaine and 2 µg/kg of fentanyl) or Group B (Paravertebral blockade will be done by probe transverse -Needle In-Plane approach with 0.25% L-Bupivacaine, 0.5 ml/kg and 2 µg/kg of fentanyl). The primary objective was to compare the effect of paravertebral blockade to single shot epidural blockade on postthoracotomy pain control, the length of stay (LOS), supplemental analgesic requirements, and the incidence of adverse respiratory events were also measured. Results: Forty neonates completed the study. Group A remained hemodynamically stable in the intraoperative period with good quality of analgesia for 8 hours postoperative with a lesser doses of rescue opioids required to maintain adequate analgesia, while in group B, paravertebral analgesic effects continued for about 4 hours postoperative with multiple dosage of rescue opioids (fentanyl) was required to maintain adequate analgesia which increased length of hospital stay Conclusion: Very efficient postoperative analgesia can be achieved via single shot epidural blockade compared to paravertebral blockade in neonatal postthoracotomy pain.