Somatic paravertebral block decreases opioid requirements in children undergoing appendectomy

• Published in: Canadian journal of anesthesia Vol. 57; no. 3; pp. 206 - 210
• Main Authors: Splinter, William M., Thomson, Margaret E.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.03.2010; Springer; Springer Nature B.V
• Subjects: Adolescent; Amides - therapeutic use; Analgesics; Analgesics, Opioid - administration & dosage; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Anesthetics, Local - administration & dosage; Appendectomy; Biological and medical sciences; Cardiology; Child; Child, Preschool; Critical Care Medicine; Female; Fentanyl; Humans; Intensive; Male; Medical sciences; Medicine; Medicine & Public Health; Morphine; Morphine - administration & dosage; Narcotics; Nerve Block - methods; Pain; Pain Medicine; Pain, Postoperative - drug therapy; Pediatrics; Pneumology/Respiratory System; Prospective Studies; Reports of Original Investigations; Surgery; Treatment Outcome; Morphine; Ropivacaine; Pregabalin; Open Appendectomy; Ketorolac; Human; Anesthesia; Appendectomy; Child
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-009-9239-y

Purpose Somatic paravertebral block (SPVB) appears to provide effective and prolonged nerve block in children; however, study of its use in this population is limited. We compared SPVB with no block in children undergoing appendectomy. Methods Thirty-six children aged 3-16 yr undergoing open appendectomy were involved in this prospective randomized controlled study. Anesthesia was induced with propofol and maintained with isoflurane in N 2 O/oxygen. All subjects received fentanyl, acetaminophen and ketorolac during anesthesia. Group I (SPVB) subjects received a right SPVB at T 11 , T 12 , and L 1 using 0.2% ropivacaine 0.25 mL·kg −1 with epinephrine 1:200,000 preoperatively. Group II (Control) had only bandaids applied to skin. Both groups were given morphine 0.05 mg·kg −1 iv every 2 hr if pain scores reached 5/10 on a visual analogue scale. Acetaminophen was administered postoperatively every 6 hr to both groups. Time to first dose of morphine, total dose of morphine in 24 hr, and any adverse effects up to 24 hr after surgery were recorded. Results Group I (SPVB) subjects required significantly less morphine than Group II (Control) patients (0.12 ± 0.07 vs 0.34 ± 0.15 mg·kg −1 , respectively; P  < 0.001), and time to their first dose was significantly longer (7.1 ± 4.4 vs 2.5 ± 1.6 hr, respectively; P  < 0.001). Incidence of vomiting was 11% with Group I and 27% with Group II ( P  = 0.21). No other adverse effects were observed in either group. Conclusions In children undergoing appendectomy, SPVB provides better pain relief than no block and reduces opioid requirements. Side effects were not statistically different between groups.