[Thoracic epidural analgesia vs patient-controlled analgesia with intravenous fentanyl in children treated for pectus excavatum with the Nuss procedure].

Abstract

BACKGROUND AND OBJECTIVE:

Thoracic epidural analgesia and patient-controlled analgesia (PCA) with intravenous fentanyl have both been shown to be effective in pediatric patients treated surgically for pectus excavatum using the Nuss procedure. We compare the efficacy and safety of these techniques.

METHODS:

Retrospective study of pediatric cases in which the Nuss procedure was used to treat pectus excavatum between October 1997 and February 2009. Weight, age, sex, and Haller index were analyzed. Pain was assessed every 8 hours on a visual analog scale of 0 to 10 or on a scale based on observation of distress (LLANTO scale). Daily use of analgesics was also recorded. The incidence of catheter-related complications or adverse events of treatment such as nausea, vomiting, and respiratory depression were also noted.

RESULTS:

We identified 31 patients in 2 groups: the epidural group (n=22) and the PCA group (n=9). Demographic characteristics, the incidences of complications or adverse events, and mean (SD) pain scores (epidural group, 1.8 [3.8]; PCA group, 2.1 [3.4]; P = .775) were statistically similar in the 2 groups. However, analgesic requirements and the duration of analgesic use in days differed significantly, at 2.9 (1.1) days in the epidural group and 5.9 (1.4) days in the PCA group (P =.001).

CONCLUSIONS:

The efficacy and safety of thoracic epidural analgesia is similar to that of PCA with intravenous fentanyl, although the use of epidural analgesia is associated with a markedly shorter duration of requirement for postoperative analgesia.

• Authors: F Reinoso-Barbero, A Fernández, P Durán, L E Castro, G Campo, M M Melo
• Journal: Revista espanola de anestesiologia y reanimacion (Rev Esp Anestesiol Reanim) Vol. 57 Issue 4 Pg. 214-9 (Apr 2010) ISSN: 0034-9356 [Print] Spain
• Vernacular Title: Analgesia epidural torácica frente a analgesia con fentanilo controlada por el paciente en niños operados de pectus excavatum con la técnica de Nuss.
• PMID: 20499799 (Publication Type: Comparative Study, English Abstract, Journal Article)

Chemical References

• Analgesics, Opioid
• Fentanyl

Topics

• Analgesia, Patient-Controlled
• Analgesics, Opioid (administration & dosage)
• Child
• Electric Countershock
• Female
• Fentanyl (administration & dosage)
• Funnel Chest (surgery)
• Humans
• Infusions, Intravenous
• Male
• Orthopedic Procedures (methods)
• Retrospective Studies