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

J Pediatr Surg. 2014 Dec;49(12):1753-7. doi: 10.1016/j.jpedsurg.2014.09.014. Epub 2014 Oct 1.


Purpose: The aim of this study was to investigate the efficacy of a single shot intercostal block for pain control in pediatric patients undergoing the Nuss procedure.

Methods: A double-blind, randomized, controlled study was performed. Thirty patients received a single shot bilateral intercostal block with levobupivacaine (L group) and 30 patients with 0.9 % saline (S group). Standardized baseline analgesia was applied for all patients. Morphine consumption, pain scores, respiratory depression, nausea and vomiting, and urinary retention were recorded every 3h for 48h after surgery.

Results: The loading dose of morphine was lower (p<0.00001) in the L group. There were significantly lower morphine doses up to 6h after surgery and VAS scores up to 3h after surgery in the L group (p<0.001 and p=0.0003, respectively). The incidence of nausea and vomiting was lower in the L group (<0.00001). The incidence of urinary retention was lower in the L group (p=0.019).

Conclusions: A single shot IB is an effective additional treatment for pediatric patients undergoing the Nuss procedure and results in the reduced consumption of morphine, less postoperative pain, and fewer opioid-related adverse effects.

Keywords: Intercostal block; Morphine; Nuss procedure; Pediatric; Postoperative pain.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Anesthetics, Local
  • Bupivacaine / administration & dosage
  • Bupivacaine / analogs & derivatives*
  • Double-Blind Method
  • Female
  • Funnel Chest / surgery*
  • Humans
  • Injections
  • Intercostal Nerves
  • Levobupivacaine
  • Male
  • Nerve Block / methods*
  • Orthopedic Procedures / methods*
  • Pain Management / methods*
  • Pain Measurement
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / drug therapy*
  • Preoperative Care / methods*
  • Treatment Outcome


  • Anesthetics, Local
  • Levobupivacaine
  • Bupivacaine