CONTINUOUS EXTRAPLEURAL PARAVERTEBRAL INFUSION OF BUPIVACAINE FOR POSTTHORACOTOMY ANALGESIA IN YOUNG INFANTS

We have studied the efficacy of a continuous paravertebral infusion of bupivacaine for the management of post-thoracotomy pain in 20 infants with a median age of 5.3 weeks (range 2 days to 20 weeks). Immediatel y before chest closure, 0.25% bupivacaine 1.25 mg kg(-1) was injected into an extrapleural paravertebral catheter, inserted under direct vis ion. A continuous infusion of 0.25% bupivacaine 0.5 mg kg(-1) h(-1) wa s commenced 1 h later and terminated after 24 h. We found that extrapl eural paravertebral catheter placement under direct vision was easy in neonates and infants. The technique provided effective postoperative pain relief in 18 (90%) patients and the failure in two (10%) infants was attributed to catheter block. Mean maximum serum concentrations of bupivacaine after the loading dose and during infusion were 1.03 (SD 0.56) and 2.00 (0.63) mu g ml(-1), respectively. There were no major c omplications relating to the technique and we conclude that extrapleur al paravertebral block is a simple and effective method for post-thora cotomy analgesia in young infants.