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Post-Cardiotomy Parasternal Nerve Block with Bupivacaine May Be Associated with Reduced Post-Operative Opioid Use in Children: A Retrospective Cohort Study

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Children’s Heart Clinic PA, Minneapolis, MN 55404, USA
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Children’s Minnesota, Minneapolis, MN 55404, USA
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Mayo Clinic-Children’s Minnesota Cardiovascular Collaborative, Rochester/Minneapolis, MN 55905/55404, USA
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Children’s Research Institute, Children’s Minnesota, Minneapolis, MN 55404, USA
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Center of Pediatric Pain Medicine, Palliative Care and Integrative Medicine, Benioff Children’s Hospitals in Oakland and San Francisco, University of California at San Francisco UCSF, San Francisco, CA 94158, USA
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Department of Pain Medicine, Palliative Care and Integrative Medicine, Children’s Minnesota, Minneapolis, MN 55404, USA
*
Author to whom correspondence should be addressed.
Children 2020, 7(3), 20; https://doi.org/10.3390/children7030020
Received: 22 January 2020 / Revised: 10 February 2020 / Accepted: 3 March 2020 / Published: 11 March 2020
(This article belongs to the Section Pediatric Surgery)
Postoperative pain treatment affects immediate and long-term outcomes in children undergoing cardiac surgery. Opioids, as part of multimodal analgesia, are effective in treating pain, however, they can be disadvantageous due to adverse side effects. Therefore, we assessed whether the local anesthetic bupivacaine as a parasternal nerve block in children post-cardiac surgery is an effective adjunct to pain management. This was a retrospective cohort study of all patients who underwent cardiothoracic surgery via median sternotomy at a large children’s hospital between November 2011 and February 2014 with and without bupivacaine following the introduction of perioperative bupivacaine in late 2012 on a single unit. 62 out of 148 patients (age 3–17 years) who received bupivacaine demonstrated decreased postoperative opioid use. Within one day of surgery, patients who received bupivacaine required, on average, 0.57 mg/kg (95% CI, 0.46 to 0.68) of total morphine equivalent compared to 0.93 mg/kg (95% CI, 0.80 to 1.06) for patients who did not receive bupivacaine. This difference was statistically significant after adjusting for potential confounders (p-value = 0.002). Length of stay and intubation were shorter on average among patients who received bupivacaine, but these differences were not statistically significant after adjusting for potential confounders. The study results seem to suggest that the perioperative administration of bupivacaine may reduce opioid usage among children post-cardiotomy. View Full-Text
Keywords: pediatric pain; congenital heart surgery; congenital heart disease; pain; postoperative care; parasternal nerve block; bupivacaine; opioid pediatric pain; congenital heart surgery; congenital heart disease; pain; postoperative care; parasternal nerve block; bupivacaine; opioid
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Moga, F.X.; Lo Galbo, M.D.; Overman, D.M.; Friedrichsdorf, S.J. Post-Cardiotomy Parasternal Nerve Block with Bupivacaine May Be Associated with Reduced Post-Operative Opioid Use in Children: A Retrospective Cohort Study. Children 2020, 7, 20.

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