CONTINUOUS EXTRAPLEURAL INTERCOSTAL NERVE BLOCK FOR POST THORACOTOMY ANALGESIA IN CHILDREN

The safety and efficacy of continuous extrapleural intercostal nerve b lock has been well established in adults. This review of our initial p aediatric experience suggests a role for this technique in children an d discusses risks and benefits relative to other forms of regional ana lgesia for thoracotomy. Nine children aged one to twelve years receive d extrapleural infusions of bupivacaine 0.1-0.2% following lateral tho racotomy for lung resection. An extrapleural catheter was placed by th e surgeon prior to thoracotomy closure, and correctly positioned under direct vision external to the parietal pleura alongside the vertebral column. An intraoperative loading dose of bupivacaine, 0.25-0.5% (0.2 8+/-0.1 ml/kg, mean+/-SD) was injected so as to raise a bleb under the parietal pleura which spread longitudinally to bathe several intercos tal nerves in the paravertebral gutter. The chest wall was then closed . Infusions of bupivacaine were commenced in the recovery room and con tinued at a constant rate of 0.21+/-0.09 ml/kg/h for 72+/-15 hours. Th e mean dose of bupivacaine was 284+/-97 mu g/kg/h. Patients also recei ved standard analgesia as an intravenous morphine infusion (10-50 mu g /kg/h), ol patient-controlled analgesia. Nursing staff were specifical ly, instructed not to alter their usual management of variable rate mo rphine infusions which are titrated to adequate analgesia. Morphine re quirements in the first 48 postoperative hours remained less than 30 m u g/kg/h, oral fluids were well tolerated after 31.2+/-19.1 hours, nas ogastric tubes were removed at 16.7+/-11.2 hours. Postoperative nausea and vomiting and respiratory depression were not observed in ally pat ient and all were able to comply with physiotherapy. There were no com plications of catheter placement or bupivacaine administration Our ini tial experience suggests that this is a safe technique which minimizes complementary opioid administration and provides adequate analgesia f or children postthoracotomy for lung resection.