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4838
Intraoperative serratus anterior block for post-operative pain control after pediatric thoracotomy: a historical cohort study.
Session: MP-05b
Fri, April 20, 8-9:30 am
Uris (Shubert Complex), 6th floor

Please note, medically challenging cases are removed three months after the meeting and scientific abstracts after three years.

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Intraoperative serratus anterior block for post-operative pain control after pediatric thoracotomy: a historical cohort study.

 

Introduction

  • Thoracotomies result in substantial postoperative pain
  • Regional techniques include thoracic epidural, paravertebral, and serratus anterior (SAB)
    • SAB is a relatively new, safe and effective alternative to thoracic epidural in adults, though not well studied in children
    • We sought to examine the efficacy of the SAB as part of a multimodal regimen in pediatric patients undergoing thoracotomy

 

Methods

  • Retrospective chart review, single center, sole pediatric cardiac anesthesiologist
  • Identified patients who underwent thoracotomy
  • Exclusion criteria: pre-op opioids, post-op mechanical ventilation
  • Separated into two groups: block vs. no block
  • All blocks performed under ultrasound guidance after induction of GA prior to incision
  • Statistical analysis via two-tailed t-test
  • Primary outcome was post-op opioid consumption converted to morphine equivalent (MEQ)

 

Results

  • 18 children identified, ages 5d-15y
  • 10 received SAB as part of a multimodal pain regimen usually including dexmedetomidine, iv acetaminophen, and ketorolac
    • Diagnoses: Coarctation of the aorta, vascular ring malformation, BT shunt, thoracic duct ligation, etc.
    • LA dosage: 0.5% Bupivacaine 0.5cc/kg or 0.25% Bupivacaine 1cc/kg (n=1)
      • Most patients (n=8) received adjuvant dexamethasone IV or perineural
      • No significant differences in demographics
      • No significant additional time to perform the block
      • Reduced intraoperative opioids in SAB group (p=0.045)
      • Trend towards delayed time to rescue dose, reduced post-operative opioids up to 48 hours in SAB group
      • No block related complications noted

 

Discussion

  • Reduced intraoperative opioids in SAB group
    • Biased – practitioner aware of block
    • Trend towards reduced post-opioid requirements up to 48 hours post-op
      • Promising for block efficacy
      • No significant time added prior to anesthesia release – often a surgeon hesitation
      • We suggest no limitations of SAB based on patient size
        • Smallest SAB patient 5 days old, 3.1kg
        • Significant limitations:
          • Retrospective nature, lacks blinding, standardization
            • More prevalent use of multimodal regimen in SAB group intra-op
  • Very small sample size limits power of the study
  • Unable to examine post-op pain scores as a measure of block efficacy
    • Multiple pain scales used, even for a single patient

 

Conclusion

  • Severely limited by sample size, but trend towards significance in post-op opioid reduction shows promise for efficacy of SAB as alternative to thoracic epidural for pediatric patients undergoing thoracotomy for pediatric cardiac and thoracic pathology
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