Postoperative pain management in pediatric patients undergoing minimally invasive repair of pectus excavatum: the role of intercostal block

J Pediatr Surg. 2013 Dec;48(12):2425-30. doi: 10.1016/j.jpedsurg.2013.08.016.


Purpose: There are no published data regarding value of intercostal block following pectus excavatum repair. Our aim was to evaluate the efficacy of intercostal block in children following minimally invasive repair of pectus excavatum (MIRPE).

Methods: Forty-five patients given patient-controlled analgesia (PCA) with morphine postoperatively were studied. Twenty-six patients were given bilateral intercostal blocks after induction of anesthesia (PCA-IB group), and nineteen patients were retrospective controls without regional blockade (PCA group). All patients were followed up 24 h postoperatively.

Results: A loading dose of morphine (0,1±0,49 mg/kg) before starting PCA was used in seventeen patients in PCA group vs. no patient in PCA-IB group. Cumulative used morphine doses were lower up to 12 h after surgery in PCA-IB group (0,29±0,08 μg/kg) than in the PCA group (0,46±0,18 μg/kg), p<0,01. There were no differences in pain scores, oxygen saturation values, sedation scores, and the incidence of pulmonary adverse events between the two groups. There was a tendency towards less morphine-related adverse effects in PCA-IB group compared to PCA group (p<0,05). No complications related to the intercostal blocks were observed.

Conclusion: Bilateral intercostal blocks following MIRPE are safe and easy to perform and can diminish postoperative opioid requirement. Double-blind randomized study is required to confirm the potential to diminish opioid related side effects.

Keywords: Children; Intercostal block; Morphine; Pectus excavatum; Postoperative pain.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Adolescent
  • Analgesia, Patient-Controlled
  • Analgesics, Opioid / therapeutic use
  • Anesthetics, Local / therapeutic use
  • Bupivacaine / therapeutic use
  • Child
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Epinephrine / therapeutic use
  • Female
  • Follow-Up Studies
  • Funnel Chest / surgery*
  • Humans
  • Linear Models
  • Male
  • Minimally Invasive Surgical Procedures*
  • Morphine / therapeutic use
  • Nerve Block / methods*
  • Orthopedic Procedures* / methods
  • Pain Measurement
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / drug therapy
  • Pain, Postoperative / prevention & control*
  • Postoperative Care / methods*
  • Prospective Studies
  • Sympathomimetics / therapeutic use
  • Treatment Outcome


  • Analgesics, Opioid
  • Anesthetics, Local
  • Sympathomimetics
  • Morphine
  • Bupivacaine
  • Epinephrine