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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2018

Open Access 01-12-2018 | Research article

Role of dexamethasone in the para-vertebral block for pediatric patients undergoing aortic coarctation repair. randomized, double-blinded controlled study

Authors: Amany H. Saleh, Passaint F. Hassan, Mohamed Elayashy, Hamza M. Hamza, Mona H. Abdelhamid, Mai A. Madkour, Pierre Z. Tawadros, Heba Omar, Mohamed M. Kamel, Marwa Zayed, Mohamed Helmy

Published in: BMC Anesthesiology | Issue 1/2018

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Abstract

Background

Surgery for aortic coarctation requires special care during anesthesia due to severe pain during the lateral thoracotomy incision, intraoperative hemodynamic instability and the need for large doses of intra- and postoperative analgesics and vasodilators. Additionally, the postoperative care of patients is very important.

Aims

We aimed to compare ultrasound-guided paravertebral block performed using bupivacaine alone and bupivacaine with dexamethasone in terms of the intra- and postoperative analgesic requirements and hemodynamics, postoperative complications and ICU stay.

Study design

This was a prospective, randomized, controlled, double-blinded study.

Methods

Fifty patients aged four to 12 months scheduled for aortic coarctation surgery were randomly divided into two equal groups (n = 25). Patients in group D (dexamethasone) received 0.5 mg/kg bupivacaine 0.25% mixed with 0.1 mg/kg dexamethasone diluted with isotonic saline and those in group C (control) received 0.5 mg/kg bupivacaine 0.25% diluted with isotonic saline (total volume 15 ml in each group). Intraoperative fentanyl consumption and hemodynamics (heart rate, arterial blood pressure) at baseline, 1 min after induction, at skin incision, after 30 min, after clamping, after declamping and at the end of the surgery were recorded, along with the objective pain score (OPS) immediately postoperatively and at 4 h, 8 h, 12 h and 24 h postoperatively and the time to the first request for pethidine. The intra- and postoperative vasodilator doses, time to extubation, ICU stay duration and postoperative complications were also recorded.

Results

The postoperative OPS was significantly lower at 12 and 24 h in group D than in group C. The time to the first request for analgesia was significantly longer in group D than in group C (3.9 ± 2.23 vs 8.6 ± 0.69). Additionally, the time to extubation was significantly shorter in group D.

Conclusion

The use of dexamethasone as an adjuvant in ultrasound-guided paravertebral block in paediatric patients undergoing surgery for aortic coarctation increased the duration of postoperative analgesia with a prolonged time to the first request for analgesics It was also associated with a decreased incidence of postoperative complications.

Trial registration

Trial registration number: NCT03074773. (Prospectively registered). The initial registration date was 9/3/2017.
Literature
1.
Hastings LA, Nichols DG. Coarctation of the aorta and interrupted aortic arch in: critical heart disease in infants and children. Philadelphia: Mosby, Elsevier’s Health Sciences; 2006. p. 625–48.
2.
Wenk M, Schug SA. Perioperative pain management after thoracotomy. CurrOpinAnaesthesiol. 2011;24:8–12.
3.
Gottschalk A, Cohen SP, Yang S, Ochroch EA. Preventing and treating pain after thoracic surgery. Anesthesiology. 2006;104:594–600.CrossRef
4.
McGuinness JG, Elhassan Y, Lee SY, et al. Do high-risk infants have a poorer outcome from primary repair of coarctation? Analysis of 192 infants over 20 years. Ann Thoracic Surg. 2010;90:2023–7.CrossRef
5.
Karski JM. Practical aspects of early extubation in cardiac. J CardiothoracVascAnesth. 1995;9:30–3.
6.
Heinle JS, Diaz LK, Fox LS. Early Extubation after cardiac operation in neonates and young infants. J Thor Cardiovasc Surg. 1997;114:413–8.CrossRef
7.
Johansen A, Bennet GJ. Local effect of methylprednisolone on pain in nerve injury. the pilot study. Reg anath. 1997;22:59–6.
8.
De Cosmo G, Aceto P, Gualtieri E, Congedo E. Analgesia in thoracic surgery: the review. Minerva Anestesiol. 2009;75:393–400.PubMed
9.
Piraccini E, Pretto EA Jr, Corso RM, Gambale G. Analgesia for thoracic surgery: the role of paravertebral block. Intensive Care and Cardiovascular Anesthesia. 2011;3(3):157–60.
10.
Kotzé A, Scally A, Howell S. Efficacy and safety of different techniques of paravertebral block for analgesia after thoracotomy: a systematic review and metaregression. Br J Anaesth. 2009;103:626–36.CrossRef
11.
Norden J, Hanallah R, Getson P. Reliability of an objective pain scale in children. Journal of Pain and Symptom Management. 1991;6:196–5.CrossRef
12.
Raja Sekhar K, Venu Gopalan B, Goravanchi F, Kee Spencer S, Kowalski Alicia M.“A Comparative Study of Bupivacaine with Dexamethasone and Bupivacaine with Clonidine through Single Space Paravertebral Block for Post-Operative Analgesia in Thoracic and Abdominal Surgeries” IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279–0853, p-ISSN: 2279–0861. Volume 14, Issue 12 Ver. IV (2015), PP 52–7.
13.
El-Feky EM, El Aziz AA. Fentanyl, dexmedetomidine, dexamethasone as adjuvant to local anesthetics in caudal analgesia in pediatrics: a comparative study. Egyptian journal of anaesthesia. 2015;31(2):175–80.CrossRef
14.
Kim EM, Lee JR, Koo BN, Im YJ, Oh HJ, Lee JH. Analgesic efficacy of caudal dexamethasone combined with ropivacaine in children undergoing orchiopexy. Br J Anaesth. 2014;112(5):885–91.CrossRef
15.
Khafagy HF, Refaat AI, El-sabae HH, Youssif MA. Efficacy of epidural dexamethasone versus fentanyl on postoperative analgesia. J Anesth. 2010;24:531–6.CrossRef
16.
Mulder DS. Pain management principles and anesthesia techniques for thoracoscopy. Ann Thorac Surg. 1993;56(3):630–2.CrossRef
17.
El-Morsy GZ, El-Deeb A, El-Desouky T, Elsharkawy AA, Elgamal MA. Can thoracic paravertebral block replace thoracic epidural block in pediatric cardiac surgery? A randomized blinded study. Ann Card Anaesth. 2012;15(4):259.CrossRef
18.
Jayaram K, Durga P. Regional anesthesia for thoracotomy pain in newborns and infants-a systematic review. Trends in Anaesthesia and Critical Care; 2017.
19.
Blanloeil Y, Bizouarn P, Le Teurnier Y, Le Roux C, Rigal JC, Sellier E, Nougarède B. Postoperative analgesia by epidural methylprednisolone after posterolateral thoracotomy. Br J Anaesth. 2001;87:635–8.CrossRef
20.
Bhattacharjee DP, Piplai G, Nayak S, Maity AR, Ghosh A, Karmakar M, Rudra JS. A randomized double-blind placebo-controlled clinical trial to assess the efficacy of dexamethasone to provide postoperative analgesia after paravertebral block in patients undergoing elective thoracotomy. J Evol Med Dent Sci. 2013;2:61–8.CrossRef
21.
Mohammed AK, Hassanien HM, Sobhy R. Coarctation of the aorta: to extubate early or to extubate late. Pediatric Anesthesia and Critical Care Journal. 2016;4(1):35–42.
22.
Jewel lC, Ellerbrock K, Eisses M, Bosenberg A. Regional anesthesia vs systemic analgesia for neonatal surgery. PediatrAnesth. 2011;21:1247–58.
23.
Zorob FA, Nassar AM, El-Said T. Paravertebral and epidural blocks for post thoracotomy pain. Egyptian Journal of Hospital Medicine. 2001;3:21–35.
24.
Kairaluoma PM, Bachmann MS, Korpinen AK, Rosenberg PH, Pere PJ. Single-injection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy. Anesthesia& Analgesia. 2004;99(6):1837–43.CrossRef
25.
Türköz A, Balcı ST, Can Güner M, Ulugöl H, Vuran C, Özker E, Türköz R. Anesthesia management with single injection paravertebral block for aorta coarctation in infant. PediatricAnesthesia. 2013;23(11):1078–83.
Metadata
Title
Role of dexamethasone in the para-vertebral block for pediatric patients undergoing aortic coarctation repair. randomized, double-blinded controlled study
Authors
Amany H. Saleh
Passaint F. Hassan
Mohamed Elayashy
Hamza M. Hamza
Mona H. Abdelhamid
Mai A. Madkour
Pierre Z. Tawadros
Heba Omar
Mohamed M. Kamel
Marwa Zayed
Mohamed Helmy
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2018
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-018-0637-y

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