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Thoracic Epidural Block for postoperative analgesia in Children with Pectus Excavatum for the Nuss Procedure: a retrospective analysis of 7 cases at a Reference Childrens’ Hospital

Ana Rita Vieira1, António Moniz2, Teresa Rocha3

1 - Interno de Anestesiologia, Centro Hospitalar de Lisboa Ocidental
2 - Assistente Hospitalar Graduado, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central
3 - Chefe de Serviço, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central

- 34th annual ESRA congresso 2015 – Ljubljana, Eslovénia

Background. Pectus Excavatum is the most common congenital chest wall deformity. The Nuss procedure is the technique of choice for the repair. Although “minimally” invasive, postoperative pain is considerable. Controversy still exists regarding the best method for pain management.
Aims. To describe our experience in multimodal analgesia regimen for the Nuss procedure in children with Pectus excavatum, analyzing the applicability of thoracic epidural and finding out the efficacy and safety profile of analgesia provided using this method.
Methods. Postoperative analgesia follow-up assessment of children undergoing Nuss procedure, between November 2014 and March 2015, were reviewed retrospectively.
Results. 7 males from 14 to 17 years were enrolled. The placement of a thoracic epidural in the T6-7 interspace has been performed for all patients. An epidural infusion of ropivacaine 0.2% 0.2-0.4mg/kg/h plus morphine 30-40mcg/kg/24h has been started for the postoperative period. 2 patients received a PCEA in a rate of 4mL/h, with bolus dose of 3 mL and 15 minutes lockout. Intermitted IV paracetamol with ketorolac 0.5 mg/kg IV or metamizol 20mg/kg IV every 8 hours for 2 days were also offered to supplement the epidural analgesia. Patients kept the epidural catheter until postoperative day 4 to day 5. Pain scores ranged from 0 to 3/10 in day 0 with controlled pain after the first 24h. There was no need for supplemental pain medication. There were no side effects such respiratory depression, neurologic complications and itching. One catheter was accidentally exteriorized in day 3 and 1 patient had nausea and vomiting.
Conclusion. Thoracic epidural have been advocated as the
analgesic technique of choice in our Hospital for the provision of postoperative analgesia in children undergoing pectus excavatum repair, as part of a multimodal analgesic approach, due to its superior pain control with minimal side effects.

Palavras Chave: Pectus excavatum, toracic epidural