Paravertebral analgesia versus wound infiltration in children recovering from cardiac surgery: a randomized controlled trial

Abstract

Introduction: Optimal analgesia for thoracotomies remains unclear. Paravertebral blocks are more complex than local anesthetic infiltration but may be more effective. We therefore tested the hypothesis that paravertebral blocks provide better postoperative analgesia than local anesthetic infiltration in children recovering from cardiac surgery thoracotomies.

Methods: This was a single-center randomized double-blind trial. We recruited children aged 6-14 years with atrial or ventricular septal defects scheduled for cardiac surgery with cardiopulmonary bypass via thoracotomy were recruited. 100 patients were enrolled and randomized to either postoperative paravertebral blocks (n=50) or local anesthetic wound infiltration (n=50). We recorded opioid consumption during the initial 24 hours after surgery, along with pain scores at 6 hour intervals. Complications including postoperative nausea and vomiting and respiratory failure were also recorded.

Results: 100 patients (mean 7 years, 43% male) were included in the analysis. The only postoperative opioid used was sufentanil. Total sufentanil consumption in the first 24 hours postsurgery was 0.3±0.4 µg/kg for those receiving paravertebral blocks, significantly lower than the 0.6±0.5 µg/kg for wound infiltration (p=0.002). Faces Pain Scale-Revised pain scores were consistently lower in the paravertebral block group across all measured time points (6, 12, 18, and 24 hours), with the most pronounced difference observed at 6 hours postoperatively (1.7±2.2 vs 3.3±2.2; p<0.001). Postoperative mechanical ventilation time, ICU stay, hospitalization, and incidence of postoperative nausea and vomiting were comparable.

Conclusion: Paravertebral blocks reduced opioid consumption and pain during the first postoperative day in pediatric cardiac thoracotomies but did not accelerate recovery.

Keywords: Analgesia; Nerve Block; Pain, Postoperative; Pediatric Anesthesia.