Mechanical pleurodesis can prevent recurrence of spontaneous pneumothorax but is associated with significant postoperative pain. Adequate pain control is not only beneficial for patient comfort but also critical for mobilization and pulmonary recovery. Thoracic epidural catheters and paravertebral blocks (PVB) have been used to alleviate pain after thoracoscopic surgery. However, no studies have evaluated the safety and efficacy of PVB versus epidural analgesia versus no block in children undergoing pleurodesis.
In this retrospective case series review, data were extracted from a single institution’s integrated patient outcomes database on children who underwent thoracoscopic pleurodesis from 2013 to 2018. Demographics, operative indication, procedure performed, and perioperative pain management were assessed by chart review. Patients whose operation was converted to thoracotomy, who had an underlying diagnosis of chronic pain, or who underwent pleurodesis for other indications were excluded. The primary outcomes were post-operative pain scores and opioid consumption. Secondary outcomes included PACU length of stay, hospital length of stay, functional outcomes during recovery, and any adverse events.
66 patients met inclusion criteria: 23 received thoracic epidurals, 34 received PVBs, and 9 received no epidural/PVB. Patient characteristics did not significantly differ among groups. Although mean pain scores were statistically significantly lower in the epidural group on post-op day 1, all three groups’ pain scores were in the 1 to 3 out of 10 range during the entire postoperative period. Thus, this statistical significance had little clinical significance as all groups had good pain control. The epidural group had significantly lower opioid consumption on post-op days 0 – 2 compared to PVB. No adverse events related to epidural or PVB were noted.
We present the first analysis of epidural vs PVB (with comparison to no regional analgesia) following pleurodesis in children. Pain is well managed, regardless of the method; however, additional systemic opioid consumption was decreased in the epidural analgesia cohort. Prospective trials and comparisons with other analgesic techniques for pediatric thoracic surgeries are needed.
Thoracic epidural analgesia offers a reduction in opioid use in the first two post-op days after pleurodesis but did not produce a clinically significant reduction in pain scores in comparison to PVB or no block.
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