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Paravertebral regional blocks decrease length of stay following surgery for pectus excavatum in children.

Abstract：

PURPOSE:Management of postoperative pain following repair of pectus excavatum has traditionally included thoracic epidural analgesia, narcotics, and benzodiazepines. We hypothesized that the use of intercostal or paravertebral regional blocks could result in decreased inpatient length of stay (LOS). METHODS:We conducted a retrospective cohort study of 137 patients (118 Nuss and 19 Ravitch - Nuss and Ravitch patients were analyzed separately) who underwent surgical repair of pectus excavatum with pain management via epidural, intercostal, or paravertebral analgesia from January 2009-December 2012. Measured outcomes included LOS, pain scores, benzodiazepine/narcotic requirements, emesis, professional fees, hospital cost, and total cost. RESULTS:In the Nuss patients, LOS was significantly reduced in the paravertebral group (p<0.005) and the intercostal group (p<0.005) compared to the epidural group, but was paradoxically countered by a nonsignificant increase in total cost (p=0.09). While benzodiazepine doses/day was not increased in the paravertebral group (p=0.08), an increase was seen in narcotic use (p<0.005). Despite increased narcotic use, no differences were seen in emesis between epidural and paravertebral use. Compared to epidural, pain scores were higher for both intercostal and paravertebral on day one (p<0.005), but equivalent for paravertebral on day three (p=0.62). The Ravitch group was too small for detailed independent statistical analysis but followed the same overall trend seen in the Nuss patients. CONCLUSION:Our use of paravertebral continuous infusion pain catheters for pectus excavatum repair was an effective alternative to epidural analgesia resulting in shorter LOS but not a decrease in overall cost.

journal_name

J Pediatr Surg

journal_title

Journal of pediatric surgery

authors

Loftus PD,Elder CT,Russell KW,Spanos SP,Barnhart DC,Scaife ER,Skarda DE,Rollins MD,Meyers RL

doi

10.1016/j.jpedsurg.2015.10.037

subject

Has Abstract

pub_date

2016-01-01 00:00:00

pages

149-53

issue

1

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(15)00646-6

journal_volume

51

pub_type

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