ISSN : 1301-5680
e-ISSN : 2149-8156
TURKISH JOURNAL OF
THORACIC AND
CARDIOVASCULAR SURGERY
Turkish Journal of Thoracic and Cardiovascular Surgery     
Atrial septal defect closure via mini-thoracotomy in pediatric patients: Postoperative analgesic effect of intercostal nerve block
Dilek Altun1, Abdullah Doğan2, Ahmet Arnaz3, Adnan Yüksek4, Yusuf Kenan Yalçınbaş2, Rıza Türköz2, Sinan Aşar5, Tayyar Sarıoğlu6
1Department of Anesthesiology and Reanimation, Acıbadem Mehmet Ali Aydınlar University, Vocational School of Health Sciences, Istanbul, Turkey
2Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, Istanbul, Turkey
3Department of Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University Medical Faculty, Istanbul, Turkey
4Department of Anesthesiology and Reanimation, Acıbadem Bakırköy Hospital, Istanbul, Turkey
5Department of Anesthesiology and Reanimation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
6Department of Pediatric Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University Medical Faculty, Istanbul, Turkey
DOI : 10.5606/tgkdc.dergisi.2020.19104
Background: In this study, we evaluated the efficacy of intercostal nerve block for postoperative pain management in pediatric patients undergoing atrial septal defect closure through a right lateral mini-thoracotomy.

Methods: Between January 2016 and January 2019, a total of 63 pediatric patients (37 males, 26 females; mean age 34.8±26.8 months; range, 2 to 96 months) who underwent corrective congenital heart surgery for atrial septal defect closure through a right lateral mini-thoracotomy were retrospectively reviewed. The patients were divided into two groups as those (Group 1, n=33) receiving intercostal nerve block and general anesthesia and those (Group 2, n=30) receiving general anesthesia alone. Intravenous morphine at a dose of 0.03 mg/kg was applied as rescue analgesia to the patients with a Ramsay Sedation Scale score of >4 and Children"s Hospital of Eastern Ontario Pain Scale score of >7. The total analgesic requirement, adverse effects, duration of mechanical ventilation and length of stay in the intensive care unit were recorded.

Results: The mean duration of mechanical ventilation and intensive care unit stay was shorter in Group 1 compared to Group 2 (3.6±1.3 vs. 9.4±2.1 h; 23±2.6 vs. 30±7.2 h, respectively) (p<0.0001). The need for postoperative rescue analgesia was statistically significantly lower in Group 1 compared to Group 2 (0.3±0.5 mg vs. 1.1±0.9 mg, respectively) (p=0.003). The mean total morphine consumption was also lower in Group 1 compared to Group 2 (4.0±2.2 mg vs. 9.0±3.4 mg, respectively) (p<0.0001).

Conclusion: Intercostal nerve block before thoracotomy closure in pediatric patients undergoing atrial septal defect repair under mini-thoracotomy provides early extubation, shorter mechanical ventilation duration and intensive care unit stay, and reduced analgesic requirements.

Keywords : Atrial septal defect, intercostal nerve block, mini-thoracotomy, pediatric cardiac surgery, postoperative analgesia
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