Use of continuous retropleural bupivacaine in postoperative pain management for pediatric thoracotomy

Background/Purpose: The aim of this study was to evaluate the use of a cont inuous bupivacaine infusion into the retropleural space as an adjunct for p ostoperative pain management in pediatric thoracotomy. Methods: A retrospective chart review was performed on 13 pediatric patient s undergoing thoracotomy over a 3-year period (April 1995 through July 1997 ). In seven patients, insertion of a retropleural catheter was accomplished before closure of the thoracotomy by placing an epidural catheter posterio r to the parietal pleura. This potential space was entered two intercostal levels below the incision and advanced superiorly four intercostal spaces. Bupivacaine (0.125% or 0.25%) was infused at 0.5 mL/kg/h. Postoperative int ravenous narcotic requirement was compared between the study population (n = 7) and the control population (n = 6). Statistical analysis was conducted using the "separate" Student's t test. Results: Thirteen pediatric patients (age range, 7 to 18 years) were evalua ted for total morphine use after thoracotomy. Seven patients had anterior s pinal release and fusion, whereas five had mediastinal operations, and one patient had a lobectomy. The two groups were comparable in age, weight, and type of operation. Infusion through the retropleural catheter continued fo r an average of 3.8 days (range, 3 to 6 days). The total mean postoperative morphine requirement was 2.32 mg/kg (0.544 mg/kg/day) in the control popul ation and 0.88 mg/kg (0.204 mg/kg/day) for the patients with a retropleural catheter(P < .001). Conclusion: A continuous infusion of bupivacaine through a unique retropleu ral technique decreases the postoperative need for morphine in postoperativ e pediatric thoracotomy patients. J Pediatr Surg 34:199-201. Copyright (C) 1999 by W.B. Saunders Company.