Atrial Septal Defect Closure Via Mini-right Thoracotomy In Pediatric Patients: The Effect Of Continuous Intercostal Nerve Block
Takashi Sasaki, Kenji Suzuki, Takashi Nitta.
Nippon Medical School, Tokyo, Japan.
Objective: To see the effect of continuous intercostal nerve block in pediatric patients who underwent ASD closure via mini-right thoracotomy. Methods: Between 2014 and 2017, nine patients underwent ASD closure using cardiopulmonary bypass through right thoracotomy. The skin incision was made on anteroaxillary region and the chest was entered via the fourth intercostal space. Cardiopulmonary bypass was established with aortic and bicaval venous cannulation and ASD was closed during cardiac arrest. At the time of chest closure, intercostal nerve block was performed with levobupivacaine (0.6 mg/kg). The first five patients (group A) were only given a shot intercostal nerve block and the rest four patients (group B) were given levobupivacaine continuously (0.1 mg/kg/hr) through an indwelling catheter until chest tube removal. The vital signs and dosage of acetaminophen were compared between the groups. Results: The chest tube was removed in 1.6 and 2 days postoperatively. There was a trend of lower heart rate in group B. The respiratory rate was significantly lower in group B (p= 0.0082). The accumulated dosage of acetaminophen given by postoperative day 2 was 53.7 and 11.7 mg/kg (p= 0.039). The average length of hospital stay was 6.2 and 5.3 days respectively. Conclusions: Continuous intercostal nerve block after ASD closure via mini right thoracotomy was effective to stabilize the respiratory rate and reduce the use of analgesic medication.
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