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.

Safety of Ultrasound-Guided Transversus Thoracis Plane Block in Pediatric Cardiac Surgery: A Retrospective Cohort Study.

OBJECTIVE: Ultrasound-guided fascial plane blocks are associated with good postoperative analgesia after pediatric cardiac surgery, with improved safety profile. To the best of the authors' knowledge, this study was the first with the primary aim of assessing the safety profile of transversus thoracis plane (TTP) block in pediatric patients who underwent open cardiac surgery. DESIGN: This was a retrospective cohort study. SETTING: University hospital. PARTICIPANTS: The authors reviewed the medical records of patients aged 6 months to 18 years who underwent open cardiac surgery via median sternotomy incision and who received bilateral transversus thoracis muscle plane block from January 2019 to August 2021 in their institutional hospital. INTERVENTIONS: Patients received ultrasound-guided bilateral TTP block. MEASUREMENTS AND MAIN RESULTS: The primary outcome measure was the incidence of mechanical complications (subcutaneous hematoma, internal mammary vessels injury, pleural puncture, pneumothorax, pericardial puncture, injury of the heart, and hemopericardium). The secondary outcomes were the incidences of hypoxia, hypotension, and bradycardia after local anesthetic injection, allergy to local anesthetic, local infection, and postoperative neuropathic pain at the sternal area. A total of 236 patients who received bilateral TTP block were screened for eligibility, of whom 38 patients were excluded. Left-sided pleural and pericardial puncture occurred in 1 patient (0.5%) without clinical evidence of pneumothorax, hemopericardium, or traumatic cardiac injury as directly seen after sternotomy. One patient (0.5%) developed a self-limiting small subcutaneous hematoma. Pneumothorax, injury of internal mammary vessels, cardiac injury, and hemopericardium were not observed in any patient. No patient developed an allergy to local anesthetic, hypoxia, bradycardia, or hypotension after local anesthetic injection. Poststernotomy neuropathic pain was not recorded in any patient. CONCLUSION: The above complications were noted in patients who received TTP block, and further prospective studies with more patients are required to comment on its safety.

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.

Analgesic efficacy of ultrasound guided bilateral transversus thoracis muscle plane block in pediatric cardiac surgery: a randomized, double-blind, controlled study.

STUDY OBJECTIVE: Adequate perioperative pain control in children undergoing cardiac surgery is mandatory. Intravenous opioids and neuraxial anesthetic techniques have been used but didn't gained any popularity. The aim of the current study was to evaluate the analgesic efficacy of transversus thoracis plane (TTP) block in pediatric cardiac surgery. DESIGN: Superiority, randomized, double-blind, controlled study. SETTING: Intraoperative and postoperative in intensive care unit (ICU), Mansoura university children hospital, Egypt. PATIENTS: Eighty pediatric patients aged 2-12 years, undergoing cardiac surgery via median sternotomy, were randomly allocated into 2 equal groups, the control group and TTP block group. INTERVENTIONS: Controlled group received only fentanyl for perioperative analgesia, while TTP block was performed in the intervention group (TTP group). MEASUREMENTS: The primary outcome measure was the total dose of fentanyl in the first postoperative 24 h after extubation, while the secondary outcome measures were postoperative pain score, intraoperative fentanyl consumption, time to extubation and ICU length of stay. MAIN RESULTS: During the first postoperative 24 h, total fentanyl consumption was significantly lower (P < 0.05) in the TTP block group (9.892 ± 3.397 µg/kg) than the control group (18.500 ± 3.401 µg/kg) and modified objective pain score was significantly (P < 0.05) lower in TTP block group than the control group all over the time. Total intraoperative fentanyl requirement was significantly (P < 0.05) lower in TTP block group (8.27 ± 1.170 µg/kg) than the control group (13.72 ± 1.186 µg/kg). CONCLUSION: The use of TTP block decreased perioperative fentanyl consumption and reduced postoperative pain intensity.

Acute effects of lobectomy on right ventricular ejection fraction and mixed venous oxygen saturation.

BACKGROUND: Traditional methods of assessing the operative risk for lung resection provide only a modest ability to predict postoperative morbidity and mortality. The aim of this study was to evaluate the effect of lobectomy on pulmonary hemodynamic and gas exchange variables using the RV thermodilution ejection fraction/oximetric catheter. METHODS: We evaluated the acute postoperative effects of lung resection on hemodynamic and gas exchange parameters in 30 patients. Anesthesia was induced with thiopentone sodium and maintained with midazolam, fentanyl and pipecuronium. Intubation was performed with a double-lumen, left-sided endobronchial tube for one lung ventilation. The hemodynamic and gas exchange parameters were recorded before and after induction of anesthesia, and two hours after lung resection. These parameters were also recorded after the classification of the patients according to the underlying lung pathology. RESULTS: Lobectomy was associated with significant hemodynamic changes and good maintenance of gas exchange variables. SVI, LVSWI and RVEF were significantly decreased in the early postoperative period after lung resection. MPAP, COP, CI, SVRI, PVRI, RVSWI, and RVEDVI showed no significant changes during the perioperative period. SVO2 showed a significant increase after lung resection when compared with preinduction values, while VO2 significantly decreased. SaO2, a-A PO2, QS-QT, DO2, and O2ER showed no significant changes during the perioperative period. CONCLUSIONS: We conclude that in the acute post-resection period (up to 2 hours postoperatively) there is right and left ventricular dysfunction with good maintenance of gas exchange.