Single shot intercostal block for pain management in pediatric patients undergoing the Nuss procedure: a double-blind, randomized, controlled study

Comparison of Ultrasonography-guided Bilateral Intercostal Nerve Blocks and Conventional Patient-controlled Intravenous Analgesia for Pain Control After the Nuss Procedure in Children

“…They demonstrated that ICNBs could decrease pain intensity and improve the health-related quality of life in the immediate postoperative period. Lukosiene et al9 evaluated the effects of conventional techniques for ICNBs on acute pain after the Nuss procedure and showed that ICNBs decreased visual analog scale scores for up to 3 hours and morphine dose for up to 6 hours after surgery, which provided evidence for using the ultrasound device in the present study. Furthermore, the success rates for conventional approaches are highly dependent on operator skills and are associated with potential serious complications 29.…”

“…Previous studies have examined the analgesic effects of conventional8–9,24–26 and ultrasound-guided27,28 ICNBs in patients undergoing percutaneous nephrolithotomy,24,27 open cholecystectomy,25 breast surgery,26,28 and the Nuss procedure 8,9. They demonstrated that ICNBs could decrease pain intensity and improve the health-related quality of life in the immediate postoperative period.…”

“…However, high-dose systemic opioids may increase the incidence of undesirable adverse effects, such as respiratory depression, nausea, and vomiting. In recent years, regional anesthesia techniques, including intercostal nerve blocks (ICNBs), have been implemented in children undergoing the Nuss procedure 8,9. The advantages of ICNBs include technical simplicity, good analgesia, an opioid-sparing effect, improved pulmonary mechanics, reduced central nervous system (CNS) depression, and avoidance of urinary retention 10.…”

A retrospective comparison of thoracic epidural infusion and multimodal analgesia protocol for pain management following the minimally invasive repair of pectus excavatum

“…Additionally, some have questioned whether the added cost and failure rate with epidural analgesia is justified by the reduction in early pain scores postoperatively . More recently some have advocated reliance on multimodal analgesia protocols or alternative regional techniques including paravertebral catheters, intercostal blocks, and continuous chest wall infusions …”

“…Pain management following minimally invasive repair of pectus excavatum is challenging and varies based on institutional experience and preferences. Historically, epidural analgesia was considered the gold standard for postoperative pain management, but a variety of other techniques including wound catheters, intercostal blocks, paravertebral catheters, and multimodal protocols have been utilized in this population . The evidence demonstrating superiority of one technique compared to another for pain management is limited …”