Abstract
Postoperative pain control in neonates is a difficult management problem. The utilization of narcotics, while effective, is often a titration problem resulting in respiratory complications, may cause gastrointestinal bleeding or give inconsistent relief, frequently requiring the addition of a sedative. Regional pain relief techniques such as epidural catheters have been extremely effective in newborns but have not been widely utilized after thoracotomy because of fears of respiratory embarrassment from diaphragmatic effects. We have used continous infusion retropleural regional anesthetic agents in ten newborns undergoing repair of tracheoesophageal fistula and esophageal atresia. The technique involves placing a 20-gauge epidural catheter (Portex) through an 18-gauge transthoracic needle (Tuohy-Schliff) above the thoracotomy incision under direct vision of the surgeon. The catheter is sutured in place with a single 6-0 plain gut suture so that the egress port of the catheter is slightly cephalad and ventral to the entered intercostal space. Closure of the chest is performed in standard fashion and the retropleural space was drained with a chest tube on 5 cm H2O suction. 1/16% bupivicaine was infused at 1.6 cc/h for analgesia. All patients were extubated in the recovery room and taken directly to the neonatal ICU. Analgesia was excellent for all infants and none required supplemental pain control for their surgical procedures. This is the first description of pleural-based anesthesia for postoperative pain control in neonates. The technique provides excellent pain control for thoracotomies in these infants and does not interfere with respiratory effort. Analgesia appears to be local and somatic and diaphragmatic function is preserved. Other anatomic areas are not affected as the analgesic phenomena is localized to the operative site. The respiratory problems associated with systemic administration of potent analgesics are avoided.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Berde CB (1989) Pediatric postoperative pain management. Pediatr Clin North Am 36: 921–940
Desparmet J, Meistelman C, Barre J, et al (1987) Continous epidural infusion of bupivacaine for postoperative pain relief in children. Anesthesiology 67: 108–110
Ecoffey C, Desparment J, Maury M, et al (1985) Bupivacaine in children: pharmacokinetics following caudal anesthesia. Anesthesiology 63: 447–448
Eng J, Sabanathan S (1992) Continous paravertebral block for postthoracotomy analgesia in children. J Pediatr Surg 27: 556–557
Eyres RL, Bishop W, Oppenheim RC, et al (1983) Plasma bupivacaine concentrations in children during caudal epidural analgesia. Anaesth Int Care 11: 20–22
Kvalheim L, Reiestad F (1984) Intrapleural catheter in the management of postoperative pain. Anesthesiology 61: A231
Mather L, Mackie J (1983) The incidence of postoperative pain in children. Pain 15: 271–282
Maunuksela EL, Olkkola KT, Korpela R (1987) Measurement of pain in children with self-reporting and behavioral assessment. Clin Pharm Ther 42: 137–141
Mazoit JX, Denson DD, Samii K (1988) Pharmacokinetics of bupivacaine following caudal anesthesia in infants. Anesthesiology 68: 387–391
McCloskey JJ, Haun SE, Deshpande JK (1992) Bupivacaine toxicity secondary to continous caudal epidural infusion in children. Anesth Analg 75: 57–290
McGrath PJ, Johnson G, Goodman JT, et al (1985) CHEOPS: a behavioral scale for rating post operative pain in children. Adv Pain Res Ther 9: 395–400
McIlvaine WB, Knox RF, Fennessey PV, et al (1988) Continous infusion of bupivacaine via intrapleural catheter for analgesia after thoracotomy in children. Anesthesiology 69: 261–264
Pietropaoli JA, Keller MS, Smail DF, et al (1993) Regional anesthesia in pediatric surgery: complications and postoperative comfort level in 174 children. J Pediatr Surg 28: 560–564
Reiestad F, Stromskag KE (1986) Intrapleural catheter in the management of postoperative pain. A preliminary report. Reg Anesth 11: 89–91
Reiestad F, Stromskag KE, Holmqvist E (1986) Intrapleural administration of bupivacaine in postoperative management of pain. Anesthesiology 65: A204
Rice LJ, Vaughan M, Broadman LM, et al (1992) Successful use of patient-controlled analgesia in pediatric surgery. J Pediatr Surg 27: 392
Rosenberg PH, Scheinin BM, Lepontalo MJ, et al (1987) Continous intrapleural infusion of bupivacaine for analgesia after thoracotomy. Anesthesiology 67: 811–813
Sartorelli KH, Abajian JC, Kreutz JM, et al (1992) Improved outcome utilizing spinal anesthesia in high risk infants. J Pediatr Surg 27: 1022–1025
Seltzer JL, Larigani GE, Goldberg ME, et al (1986) A kinetic and dynamic evaluation of intrapleural bupivicaine for subcostal incisional pain. Anesthesiology 65: A213
Wolf AR, Valley RD, Fear DW, et al (1988) Bupivacaine for caudal analgesia in children: the optimum effective concentration. Anesthesiology 69: 102–106
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Vane, D.W., Pietropaoli, J.A., Smail, F.D. et al. Continous retropleural infusion for analgesia after thoracotomy in newborn infants. Pediatr Surg Int 10, 311–314 (1995). https://doi.org/10.1007/BF00182210
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00182210