Issn Print: 1098-7339

Publication Date: 2007/09/01


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Pain management after minimally invasive pectus excavatum repair: retrospective comparison of paravertebral and lumbar epidural patient-controlled analgesia: 82.

C. Stanz; A. Gutmann; M. Vittinghoff; W. Toller; J. Schleef

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Author Information: Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria

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Background and Aims: Although operative correction of pectus excavatum regarding skin incision is minimally invasive and minimal pain is expected, clinical experience revealed that postoperative pain and discomfort required statistically significant increases in days of intravenous analgesics administration compared with the standard open procedure. To avoid the disadvantages of intravenous systemic opiod administration, thoracic epidural catheter technique has been described for appropriate pain management. The use of paravertebral (PA) and lumbar epidural analgesia (LA) for this procedure has not been reported so far. The aim of this investigation was to evaluate retrospectively the efficacy and safety of these two methods.
Materials and Methods: We retrospectively analyzed protocols of 36 patients aged 8 to 25 years undergoing minimally invasive repair of pectus excavatum under general anesthesia. 19 patients had bilateral paravertebral catheters placed at the thoracic segment where the bar was planned to be inserted. 17 patients received lumbar epidural catheter placed mainly at L1-L3. Postoperative pain was assessed using the Visual Analogue Scale (1-10). Safety was assessed by incidence of adverse events.
Results: Mean VAS was not significantly different in the two groups (PA=1.1 vs. LA=0.9), and both catheter techniques provided excellent postoperative pain control. While no major adverse event occurred, both analgesic regimes were associated with a low incidence of minor adverse events, including vomiting, urinary retention, Horner's signs and pruritus, depending on the type of analgesic regime. The number of total minor adverse events in patients receiving LA was higher when compared with patients receiving PA.
Conclusions: Paravertebral analgesia turned out to be as reliable as lumbar epidural analgesia. Safety of this method of pain management was superior to LA. The technique however needs experience as paravertebral catheters can be advanced only for a limited distance and need to be fixed carefully.

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