The anesthesiologic management of bar removal after the Nuss procedure for repair of pectus excavatum

Abstract

Introduction. The anesthesiologic management of bar removal after the Nuss procedure for repair of pectus excavatum is not clearly discussed in literature. The aim of the study: analysing the anesthetic technique of bar removal after the Nuss procedure for repair of pectus excavatum. Materials and methods. The prospective randomized study included 24 adolescents undergone the bar removal after the Nuss procedure for repair of pectus excavatum under general anesthesia with tracheal intubation and artificial lung ventilation. The patients were randomized into two groups according to the analgesia technique: in group PVA (n=14) bilateral paravertebral anaesthesia was used and in group G (n=10) fentanyl was used intraoperatively and ketoprophen – postoperatively. Intravenous induction: propofol 2–3 mg/kg, fentanyl 3–4 mcg/kg, atracurium 0.6 mg/kg. The maintenance of anesthesia: propofol 6–10 mg/kg/h, fentanyl 2 mcg/kg as needed. The following parameters were analyzed: blood pressure systolic (BPs), diastolic (BPd), mean (BPm), pulse rate (PR) and pain intensity using visual analogue scale (VAS). Results: The changes in hemodynamic parameters during surgery and anesthesia were statistically significant (p<0.05), but the hemodynamics was clinically stable. BP and PR were more decreased during anesthesia in group PVA than in group G. Anesthesia was adequate in both groups. There was no need in additional fentanyl bolus after the induction dose in PVA group. Patients in G group needed additional 200 mcg fentanyl during surgery. After surgery the pain intensity was significantly higher in group G than in group PVA: at recovery from anesthesia and extubation of trachea in group PVA – 0 (0–1), in group G – 3 (2–4) (U=1.5; р=0.000002); in the evening of the day of surgery in group PVA – 1 (0–1); in group G – 3 (2–3) (U=6.0; р=0.000031); in the next morning after surgery in group PVA – 0 (0-0); in group G – 1.5 (1–2) (U=12.0; р=0.00027) cm according to VAS. There was no patient with pain intensity higher than 3 cm, so all patients had adequate analgesia. Conclusion. Bilateral paravertebral anesthesia provides more adequate analgesia than systemic administration of analgesics perioperatively for bar removal after the Nuss procedure for pectus excavatum correction. The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution. Informed consent of parents and children was obtained for the study. The author declares no conflict of interest. Key words: anesthesia, paravertebral block, pectus excavatum, Nuss procedure, bar removal.