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Title: Ultrasound guided paravertebral versus caudal epidural block in pediatric patients with acyanotic heart diseases undergoing cardiac surgery
Authors: Nayana Nemani
Issue Date: Dec-2019
Publisher: SCTIMST
Abstract: Cardiac surgery with cardiopulmonary bypass elicits intense inflammatory and stress response which persists into the immediate postoperative period. This subsequently contributes to the development of postoperative complications such as myocardial dysfunction, respiratory insufficiency and postoperative organ dysfunction and injury.1, 2 Pain following cardiac surgery may be related to the sternotomy incision, intraoperative tissue dissection, vascular cannulation, chest tube insertion.1 The stress response to surgery is characterized by neurohumoral, immunologic, metabolic and endocrine derangements leading to increased secretion of catabolic hormones like cortisol and catecholamines.1 All these can cause adverse effects such as tachycardia, hypertension, increased oxygen consumption, catabolism, and impaired immune function.2 An appropriate anaesthetic technique can alleviate perioperative stress. This may positively impact the overall surgical outcome. One of the most intriguing aspects of regional anaesthesia is its ability to attenuate the stress response to surgery.3 Pre-emptive thoracic paravertebral block has become an increasingly popular alternative to thoracic epidural as an adjuvant to general anaesthesia.4,5 Ultrasound guided thoracic paravertebral block is superior to landmark technique as the needle can easily be visualized and the drugs can be deposited in the correct space. Thus, there is less incidence of pneumothorax and failed block.6Although few studies have evaluated the role of unilateral thoracic paravertebral block in children undergoing non cardiac surgery under thoracotomy,7,8 there is very limited evidence supporting the efficacy of bilateral thoracic paravertebral block in children undergoing cardiac surgery through a median sternotomy.9 There are no large scale prospective studies done on caudal epidural block in pediatric cardiac surgery. Most of the studies which we reviewed were retrospective in nature and were inconclusive about the efficacy of caudal analgesia. 10,11 Levyi et al found a higher early extubation rate in tetralogy of Fallot patients who received caudal epidural block.11 One prospective study done on the effect of caudal bupivacaine and sufentanil on stress response found it to be beneficial and demonstrated a significant reduction of serum cortisol levels in pediatric cardiac surgical patients who received the block.12 There are no studies done on the effectiveness of ultrasound guided caudal block and comparing it with ultrasound guided bilateral thoracic paravertebral block in pediatric cardiac surgical patients. Hence, we propose to assess the efficacy of ultrasound guided bilateral thoracic paravertebral block and caudal epidural block in attenuating the intraoperative hemodynamic and stress response in children undergoing open heart surgery through a median sternotomy approach
Appears in Collections:Anaesthesia

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