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639: Paravertebral Block as an Operative and Postoperative Anesthetic and Analgesia Option for Thoracic Pediatric Surgery
232
Posters
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Pediatrics
532. Combined anesthesia in nuss operation - case report A. Sa´1, A. Azevedo2, T. Rocha3 1Hospital Curry Cabral, Anesthesiology, Lisbon, Portugal, 2Hospital Fernando Fonseca, Anesthesiology, Lisbon, Portugal, 3Hospital D. Estefaˆnia, Anesthesiology, Lisbon, Portugal Background and Aims: The effectiveness and benefits from epidural analgesia is well documented in international literature. Although not widely spread thoracic epidural in pediatric population, we report a case of young male submit to minimally invasive Nuss intervention under combined anesthesia, using the epidural catheter to promote pos-operative analgesia. Methods: Case Report Results: We present a case of 12 year-old male patient with pectus escavatum recurrence scheduled for surgery by Nuss technique. We performed a high lumbar epidural anesthesia (L1-L2), intraepidural placement of catheter 7 cm after induction of general anesthesia. Previous attempts for thoracic epidural failed. Intraoperative period occurred without major complications except a sudden and self-limited disrhythm due to direct compression of the heart. Post-operative period was in Intensive Care Unit (ICU). Epidural analgesia was made by institutional protocol (using morphine and methylprednisolone). Because of pain complaints in first pos-operative hours there was initiated an alfentanil ev perfusion (3microg/Kg/h) without success either. 24 hours after we introduce a perfusion of ropivacaine epidural (0,2%, 5ml/h) for 4 days. The patient was transferred to ward on the day 4 without complaints. There where no side effects such as sedation, motor block, nausea and vomiting nor technical complications like intravascular injection, infection or neurological complaints. Conclusions: Epidural analgesia is a higher effectiveness technique for control of pos-operative pain, particularly in thoracic surgery. Given the risk/benefit, after failed attempt of thoracic epidural (first choice technique) we have chosen to perform modified lumbar epidural technique successfully.
639. Paravertebral block as an operative and postoperative anesthetic and analgesia option for thoracic pediatric surgery M. Pelaez, M. Hervias, P. Troncoso, J. Cebrian, M. Garcia Navlet, A. Peleteiro, T. Lopez-Gil Hospital General Universitario Gregorio Maran˜on, Seccion Anestesia Pediatrica, Madrid, Spain Background: Thoracic surgery is known to need high narcotic analgesia during the operative and the postoperative period a cause of the plerural irritation and costal distraction. Regional techniques are ideal for this purpose. Regional anesthesia is also posible in children but there are some technical difficulties associated to them. Paravertebral block has less morbidity and it is more easy to perform than the epidural block while it is as effective. Methods and Results: we describe in a video a background of the regional thoracic analgesia options in children followed by the paravertebral block technique with insertion of a catheter, its posible complications and its advantages over the thoracic epidural block in children. We show the intraoperative anesthetic dosage for this block and our postoperative pain protocol with ropivacaine perfusion through the catheter. Conclusions: Paravertebral block with catheter insertion for postoperative pain control in pediatric thoracic surgery is safe and effective. It is an easy technique and it permits a reduction of narcotic use in both the intraoperative and postoperative period.
Posters
•
Pediatrics
532. Combined anesthesia in nuss operation - case report A. Sa´1, A. Azevedo2, T. Rocha3 1Hospital Curry Cabral, Anesthesiology, Lisbon, Portugal, 2Hospital Fernando Fonseca, Anesthesiology, Lisbon, Portugal, 3Hospital D. Estefaˆnia, Anesthesiology, Lisbon, Portugal Background and Aims: The effectiveness and benefits from epidural analgesia is well documented in international literature. Although not widely spread thoracic epidural in pediatric population, we report a case of young male submit to minimally invasive Nuss intervention under combined anesthesia, using the epidural catheter to promote pos-operative analgesia. Methods: Case Report Results: We present a case of 12 year-old male patient with pectus escavatum recurrence scheduled for surgery by Nuss technique. We performed a high lumbar epidural anesthesia (L1-L2), intraepidural placement of catheter 7 cm after induction of general anesthesia. Previous attempts for thoracic epidural failed. Intraoperative period occurred without major complications except a sudden and self-limited disrhythm due to direct compression of the heart. Post-operative period was in Intensive Care Unit (ICU). Epidural analgesia was made by institutional protocol (using morphine and methylprednisolone). Because of pain complaints in first pos-operative hours there was initiated an alfentanil ev perfusion (3microg/Kg/h) without success either. 24 hours after we introduce a perfusion of ropivacaine epidural (0,2%, 5ml/h) for 4 days. The patient was transferred to ward on the day 4 without complaints. There where no side effects such as sedation, motor block, nausea and vomiting nor technical complications like intravascular injection, infection or neurological complaints. Conclusions: Epidural analgesia is a higher effectiveness technique for control of pos-operative pain, particularly in thoracic surgery. Given the risk/benefit, after failed attempt of thoracic epidural (first choice technique) we have chosen to perform modified lumbar epidural technique successfully.
639. Paravertebral block as an operative and postoperative anesthetic and analgesia option for thoracic pediatric surgery M. Pelaez, M. Hervias, P. Troncoso, J. Cebrian, M. Garcia Navlet, A. Peleteiro, T. Lopez-Gil Hospital General Universitario Gregorio Maran˜on, Seccion Anestesia Pediatrica, Madrid, Spain Background: Thoracic surgery is known to need high narcotic analgesia during the operative and the postoperative period a cause of the plerural irritation and costal distraction. Regional techniques are ideal for this purpose. Regional anesthesia is also posible in children but there are some technical difficulties associated to them. Paravertebral block has less morbidity and it is more easy to perform than the epidural block while it is as effective. Methods and Results: we describe in a video a background of the regional thoracic analgesia options in children followed by the paravertebral block technique with insertion of a catheter, its posible complications and its advantages over the thoracic epidural block in children. We show the intraoperative anesthetic dosage for this block and our postoperative pain protocol with ropivacaine perfusion through the catheter. Conclusions: Paravertebral block with catheter insertion for postoperative pain control in pediatric thoracic surgery is safe and effective. It is an easy technique and it permits a reduction of narcotic use in both the intraoperative and postoperative period.