Pain Control After Thoracotomy in Pediatric Patients Comparing Thoracic Epidural Analgesia with Intercostal Nerve Block : A Pilot Study
Boonmak P, Boonmak S, Horatanaruang D, Boonpadhanapong S
Department of Anesthesiology, Faculty of Medicine, Khonkaen University, Khonkaen
Objective : To compare the effectiveness of intercostal nerve block and thoracic epidural analgesia for postoperative pain control after thoracotomy in pediatric patientsMethods : A double blind randomized controlled trial, a pilot study, was conducted in 12 children (5-12 year old, ASA class 2) who were scheduled for elective thoracotomy at Srinagarin Hospital. They were randomly divided into 2 groups, thoracic epidural block (TEB) and intercostal nerve block (ICNB). Anesthetic management included atropine and fentanyl for premedication, thiopental and succinyl choline for induction and tracheal intubation as well as atracurium, N2O, O2 and isoflurane for maintenance. In TEB group, after intubation of the trachea thoracic epidural catheters were placed by anesthesiologist at the level of T5-T6 using Touhy needle NO. 18 gauge with loss of resistance technique. After negative response to test dose, 0.25% bupivacaine with adrenaline (1:200,000) 0.35 ml/kg was injected via the catheter.In ICNB group, before closure of the incision intercostal nerve block using 0.25% bupivacaine with adrenaline (1:200,000) 1 ml/kg was performed by surgeon. Pain score was evaluated at immediate, 1 hr, 2 hr, 6 hr and 24 hr after operation using CHEOPS scores or face scales. All patients received tramadol 1.5 mg/kg intravenously every 6 hr for 24 hr.Result : There were no difference in additional analgesic drug usage at 1 hr and 2 hr after operation as well as in CHEOPS scores or face scales at 1 hr, 2 hr, 6 hr after surgery. Conclusion : TEB and ICNB can be used safely to control post thoracotomy pain. To compare the effectiveness of these two techniques, further study with larger sample size may be needed because several factors can confound the results.
วิสัญญีสาร ปี 2545, January-March ปีที่: 28 ฉบับที่ 1 หน้า
intercostal nerve block, Pediatric thoracotomy, thoracic epidural block