The effect of continuous wound infusion of ropivacaine on postoperative pain after median sternotomy and mediastinal drain in children

Mattila, Ilkka; Pätilä, Tommi; Rautiainen, Paula; Korpela, Reijo; Nikander, Satu; Puntila, Juha; Salminen, Jukka; Suominen, Pertti; Tynkkynen, Paula; Hiller, Arja

doi:10.1111/pan.12919

Cited by 19 publications

(12 citation statements)

References 27 publications

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“…The infusion dose at maximum of 0.4/mg/kg was effective and plasma levels remained below the toxic threshold. However, in preschool children undergoing atrial septal defect (ASD) closure by median sternotomy, continuous wound infusion of ropivacaine by a single catheter placed over the sternum connected to an elastomeric pump did not show difference in morphine consumption, pain scores, or nausea and vomiting when compared to placebo . Pain from the mediastinal drains were not covered by the local anesthetic infusion and may have influenced the outcomes.…”

Section: Continuous Local Anesthetic Wound Infusionmentioning

confidence: 99%

“…However, in preschool children undergoing atrial septal defect (ASD) closure by median sternotomy, continuous wound infusion of ropivacaine by a single catheter placed over the sternum connected to an elastomeric pump did not show difference in morphine consumption, pain scores, or nausea and vomiting when compared to placebo. 63 Pain from the mediastinal drains were not covered by the local anesthetic infusion and may have influenced the outcomes. Local anesthetic infiltration of drain sites as well as the intravenous dexamethasone given in above study by Tirotta 62 may have explained the different outcomes in these studies.…”

Section: Wound Infiltr Ati Onmentioning

confidence: 99%

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Regional anesthesia for sternotomy and bypass—Beyond the epidural

Raj

2019

Pediatric Anesthesia

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Summary Systemic opioids have been the main stay for the management of perioperative pain in children undergoing cardiac surgery with sternotomy. The location, distribution, and duration of pain in these children have not been studied as extensively as in adults. Currently, there is no consensus to the dose of opioids required to provide optimum analgesia and attenuate the stress response while minimizing their unwanted side effects. At present there is a tendency to use lower dose aiming for early extubation and minimize opioid‐related side effects, but this may not obtund the stress response in all children. The development of chronic pain although rare when compared to adults is still a risk that needs further investigation. Regional anesthetic techniques, by blocking the afferent impulses, have been shown to be advantageous in reducing the stress response to surgery as well as pain and opioid requirements in children up to 24 hours after cardiac surgery. Central neuraxial blockades have not gained wide spread acceptance in these procedures due to the worry of hematoma, although rare, leading to catastrophic neurological outcomes. This review focuses on blocks outside the vertebral column, ie, peripheral nerve blocks, performed either in the front or the back of the chest wall to target the thoracic intercostal nerves. Techniques of ultrasound‐guided bilateral single shot paravertebral block and erector spinae block posteriorly and transversus thoracic plane block anteriorly are discussed. In addition, parasternal block and wound infiltration by surgeon as well as continuous local anesthetic infusion via catheters placed at end of procedures are summarized. Current evidence available for use of these techniques in children undergoing cardiac surgery are reviewed. These are based on small studies and case series and further studies are required to evaluate the risks and benefits of local anesthetic blocks in children undergoing cardiac surgery.

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Section: Continuous Local Anesthetic Wound Infusionmentioning

confidence: 99%

Section: Wound Infiltr Ati Onmentioning

confidence: 99%

Regional anesthesia for sternotomy and bypass—Beyond the epidural

Raj

2019

Pediatric Anesthesia

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“…In 4-yr-olds, these perioperative ratings were based on an observational pain scale (OPS) with five objective behavioural parameters (crying, facial expression, position of torso, position of legs, motor restlessness) and three assignable scores (0, none; 1, moderate; 2, severe) for each of them. 13 In >4-yr-olds, we used a VAS with 10 grades. Thirst and hunger were evaluated before operation, and nausea and vomiting after operation, in a binary fashion (0, absent; 1, present).…”

Section: Outcome Parametersmentioning

confidence: 99%

Randomised controlled trial comparing preoperative carbohydrate loading with standard fasting in paediatric anaesthesia

Tudor-Drobjewski

Marhofer

Kimberger

et al. 2018

British Journal of Anaesthesia

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“…There is limited evidence regarding the perioperative use of sodium-channel blockers in patients undergoing open-heart surgery. One recent study by Mattila et al in 49 children aged 1-9 years could not demonstrate that a continuous ropivacaine wound infusion reduced morphine consumption, pain score or values, or nausea and vomiting in children who underwent atrium septum defect closure with median sternotomy and mediastinal drain [46]. One adult study on a continuous infusion of ropivacaine into the sternal wound following cardiac surgery was discontinued early due to an increased incidence of sternal wound infection [47].…”

Section: Discussionmentioning

confidence: 99%

Post-Cardiotomy Parasternal Nerve Block with Bupivacaine May Be Associated with Reduced Post-Operative Opioid Use in Children: A Retrospective Cohort Study

et al. 2020

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Postoperative pain treatment affects immediate and long-term outcomes in children undergoing cardiac surgery. Opioids, as part of multimodal analgesia, are effective in treating pain, however, they can be disadvantageous due to adverse side effects. Therefore, we assessed whether the local anesthetic bupivacaine as a parasternal nerve block in children post-cardiac surgery is an effective adjunct to pain management. This was a retrospective cohort study of all patients who underwent cardiothoracic surgery via median sternotomy at a large children’s hospital between November 2011 and February 2014 with and without bupivacaine following the introduction of perioperative bupivacaine in late 2012 on a single unit. 62 out of 148 patients (age 3–17 years) who received bupivacaine demonstrated decreased postoperative opioid use. Within one day of surgery, patients who received bupivacaine required, on average, 0.57 mg/kg (95% CI, 0.46 to 0.68) of total morphine equivalent compared to 0.93 mg/kg (95% CI, 0.80 to 1.06) for patients who did not receive bupivacaine. This difference was statistically significant after adjusting for potential confounders (p-value = 0.002). Length of stay and intubation were shorter on average among patients who received bupivacaine, but these differences were not statistically significant after adjusting for potential confounders. The study results seem to suggest that the perioperative administration of bupivacaine may reduce opioid usage among children post-cardiotomy.

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The effect of continuous wound infusion of ropivacaine on postoperative pain after median sternotomy and mediastinal drain in children

Abstract: Contrary to our hypothesis, continuous ropivacaine wound infusion did not reduce morphine consumption, pain score values, or nausea and vomiting in children who underwent ASD closure with median sternotomy and mediastinal drain.

Cited by 19 publications

References 27 publications

Regional anesthesia for sternotomy and bypass—Beyond the epidural

Regional anesthesia for sternotomy and bypass—Beyond the epidural

Randomised controlled trial comparing preoperative carbohydrate loading with standard fasting in paediatric anaesthesia

Post-Cardiotomy Parasternal Nerve Block with Bupivacaine May Be Associated with Reduced Post-Operative Opioid Use in Children: A Retrospective Cohort Study

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