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Comparison of caudal ropivacaine‐morphine and paravertebral catheter for major upper abdominal surgery in infants
Author(s) -
Sato Makoto,
Iida Takafumi,
Kikuchi Chika,
Sasakawa Tomoki,
Kunisawa Takayuki
Publication year - 2017
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.13104
Subject(s) - medicine , ropivacaine , anesthesia , perioperative , morphine , surgery , abdominal surgery , analgesic , catheter
Background The caudal epidural block is one of the most commonly used regional anesthetic techniques in children. Administration of morphine via caudal injection enables analgesia, even for upper abdominal surgery. The thoracic paravertebral block has also been successfully used to treat perioperative pain during upper abdominal procedures in pediatric patients. Aim In the current study, we compared the two regional techniques for upper abdominal surgery in infants to determine whether one of them was preferable to the other. Methods Consecutive patients under 12 months of age who underwent upper abdominal surgery were retrospectively divided according to the chosen postoperative analgesia: Group C, caudal ropivacaine‐morphine; Group P, paravertebral catheter. We analyzed the following outcomes: requirement for additional analgesics, pain scores, need for mechanical ventilation and oxygen dosage, postoperative blood pressure and heart rate, time to pass first stool, time until first full meal, and complications. Results Twenty‐one consecutive patients were included: 10 in Group C and 11 in Group P. Median age at surgery was 80 (47.5−270.0) and 84.5 (34.3−287.5) days, respectively. No difference was found between the two groups in requirement for additional analgesics at 24 h after surgery (median 1 in Group C vs 1 in Group P, P = 0.288, 95% CI: −2 to 1). BOPS pain scores were only lower in Group P when compared to Group C at 24 h after surgery (median 1 vs 2, P = 0.041, 95% CI: −2 to 0). None of the patients had perioperative complications. Conclusions In this small series, there was no significant difference between caudal ropivacaine‐morphine and paravertebral catheter for postoperative care in infants undergoing upper abdominal surgery. Further prospective studies are needed to compare the efficacy and incidence of complications of caudal block and paravertebral catheter for postoperative analgesia.