The effect of ultrasound-guided bilateral thoracic retrolaminar block on analgesia after pediatric open cardiac surgery: a randomized controlled double-blind study.

BACKGROUND: The thoracic retrolaminar block (TRLB) is a relatively new regional analgesia technique that can be used as an alternative to the thoracic paravertebral block. This study aimed to evaluate the postoperative analgesia effects of ultrasound-guided TRLB in children undergoing open cardiac surgery via median sternotomy incision. METHODS: Sixty-six patients aged 2-8 years were recruited. In the TRLB group, 0.25% bupivacaine 0.4 ml/kg was injected into the retrolaminar space on both sides at the level of the T4 lamina. Patients in the control group were injected with 0.9% saline. The primary outcome measure was fentanyl consumption in the first 24 h post-extubation. The secondary outcome measures were the total intraoperative fentanyl consumption, postoperative modified objective pain score (MOPS), and time to extubation. RESULTS: The total intraoperative fentanyl requirements and fentanyl consumption in the first 24 h post-extubation were significantly lower (P < 0.001) in the TRLB group (9.3 ± 1.2; 6.9 ± 2.1 µg/kg, respectively) than in the control group (12.5 ± 1.4; 16.6 ± 2.8, respectively). The median (Q1, Q3) time to extubation was significantly shorter (P < 0.001) in the TRLB group (2 [1, 3] h) than in the control group (6 [4.5, 6] h). The MOPS was significantly lower (P < 0.05) in the TRLB group than in the control group at 0, 2, 4, 8, 12 and 16 h post-extubation. CONCLUSIONS: Bilateral ultrasound-guided TRLB is effective in providing postoperative analgesia in children undergoing open cardiac surgery via median sternotomy incision.

Ultrasound-Guided Long-Axis Versus Short-Axis Femoral Artery Catheterization in Neonates and Infants Undergoing Cardiac Surgery: A Randomized Controlled Study.

OBJECTIVE: The objective of the present study was to compare ultrasound-guided long-axis (LAX) and short-axis (SAX) femoral artery catheterization in neonates and infants undergoing cardiac surgery. DESIGN: A single-center, prospective, randomized, single-blinded, controlled study. SETTING: This study was conducted in the operating room and intensive care unit of the division of cardiac surgery, Mansoura University Children's Hospital, Egypt. PARTICIPANTS: Ninety neonates and infants undergoing elective cardiac surgery were enrolled in this study and randomly allocated to ultrasound-guided LAX and SAX groups. INTERVENTIONS: Ultrasound-guided femoral artery catheterization was done using either LAX (in-plane) or SAX (out-of-plane) technique. MEASUREMENTS AND MAIN RESULTS: The primary outcome measure was the rate of a successful first puncture. The secondary outcome measures were the rates of mechanical complications, failure rate, time to a successful first, second, and third puncture, total time of catheterization, and imaging time. The first puncture success rate was significantly higher (p = 0.048) in the LAX group (34 of 41, 82.9%) than in the SAX group (25 of 41, 60.9%). The mean time to a successful first puncture was significantly shorter (p < 0.001) in the LAX group (153.1 ± 30.1 seconds) than in the SAX group (227.2 ± 48.8 seconds). The total catheterization time was significantly shorter in the LAX group than in the SAX group. There was no significant difference in the rate of complication. CONCLUSION: With a single experienced operator performing the ultrasound-guided femoral artery cannulation, the LAX technique resulted in a higher first puncture success rate and shorter time to cannulation than the SAX technique.

The direct comparison of inhaled versus intravenous levosimendan in children with pulmonary hypertension undergoing on-cardiopulmonary bypass cardiac surgery: A randomized, controlled, non-inferiority study.

STUDY OBJECTIVE: Pulmonary arterial hypertension is commonly seen in children with left to right intracardiac shunts and affects the outcomes of cardiac surgery. Our study aimed to compare the efficacy of inhaled levosimendan (LS) versus intravenous LS in reducing elevated pulmonary artery pressure (PAP) in children scheduled for cardiac surgery. DESIGN: Non-inferiority, prospective, randomized, blinded, controlled study. SETTING: Operative room and intensive care unit (ICU), institutional children's hospital of Mansoura Faculty of Medicine, Egypt. PATIENTS: 50 patients of either sex, aged 1 to 5 years undergoing surgical repair of intracardiac left to right shunt complicated by pulmonary hypertension were recruited for the study. INTERVENTIONS: In the intravenous LS group, patients received intravenous infusion of LS a rate of 0.1 µg/kg/min and in the inhaled LS group, LS (36 µg/kg/6 h) was delivered by nebulization. MEASUREMENTS: The primary endpoint was systolic PAP, while the secondary endpoints were the heart rate, mean arterial blood pressure, dose of norepinephrine, time to extubation and ICU length of stay. MAIN RESULTS: Both intravenous and inhaled routes of LS similarly reduced the high systolic PAP over all time points of measurement and intravenous LS was associated with higher heart rate, lower arterial pressure and the need for a higher dose of norepinephrine than the inhaled LS. CONCLUSION: Inhalation of LS is non-inferior to intravenous LS in reducing high PAP in children who underwent on-pump cardiac surgery and it is associated with less tachycardia and hypotension with reduced need for vasoactive drugs.

Preemptive analgesic efficacy of ultrasound-guided transversalis fascia plane block in children undergoing inguinal herniorrhaphy: a randomized, double-blind, controlled study.

BACKGROUND: Surgical repair of congenital inguinal hernia results in significant postoperative discomfort and pain. The aim of the current study was to evaluate the pre-emptive analgesic efficacy of a transversalis fascia plane (TFP) block after pediatric inguinal herniorrhaphy. METHODS: Forty-four patients aged 12 to 60 months who underwent unilateral inguinal herniorrhaphy were enrolled. Four patients were excluded, and the remaining were allocated to the control group and the TFP block group. In the TFP block group, 0.4 mL/kg bupivacaine 0.25% was instilled in the plane between the transversus abdominis and transversalis fascia, while in the control group 0.9% saline was used instead of bupivacaine. The collected data were the total dose of paracetamol consumed during the first 12 h postoperatively, the postoperative Face, Leg, Activity, Cry, Consolability (FLACC) pain score, time to first use of rescue analgesia, number of patients required additional postoperative analgesics, and parents' satisfaction. RESULTS: The median paracetamol consumption was significantly lower in the TFP block group than in the control group, and FLACC pain scores were significantly lower for all study times in the TFP block group with higher parental satisfaction scores than those for the control group. The number of patients who required additional analgesics was significantly lower in the TFP block group than in the control group. CONCLUSIONS: The use of a TFP block decreases postoperative analgesic consumption and postoperative pain intensity after pediatric inguinal herniorrhaphy. Future studies with larger sample size are required to evaluate the actual complications rate of TFP block.