The effect of continuous wound infusion of ropivacaine on postoperative pain after median sternotomy and mediastinal drain in children

• Published in: Pediatric anesthesia 2016-07, Vol.26 (7), p.727-733
• Main Authors: Mattila, Ilkka, Pätilä, Tommi, Rautiainen, Paula, Korpela, Reijo, Nikander, Satu, Puntila, Juha, Salminen, Jukka, Suominen, Pertti K., Tynkkynen, Paula, Hiller, Arja
• Format: Article
• Language: English
• Subjects: Amides - administration & dosage; Amides - therapeutic use; analgesia; anesthetic techniques; Anesthetics, Local - administration & dosage; Anesthetics, Local - therapeutic use; Child; Child, Preschool; continuous ropivacaine infusion; Double-Blind Method; Drainage; Female; Humans; Infant; Infusions, Parenteral - methods; Male; Mediastinum - surgery; Pain, Postoperative - drug therapy; pediatrics; postoperative; Prospective Studies; regional; Sternotomy; surgery; Treatment Outcome
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/pan.12919

Summary Background Postoperative pain after median sternotomy is usually treated with i.v. opioids. We hypothesized that continuous wound infusion of ropivacaine decreases postoperative morphine consumption and improves analgesia in children who undergo cardiac surgery. Methods This randomized, double‐blind study comprised 49 children aged 1–9 years who underwent atrial septal defect (ASD) closure. Patients received continuous local anesthetic wound infiltration either with 0.2% ropivacaine, 0.3–0.4 mg·kg−1·h−1 (Group R) or with saline (Group C). Rescue morphine consumption, Objective Pain Scale (OPS), time to mobilization, time to enteral food intake, and time to discharge were recorded. Results There were no statistically significant differences in morphine consumption at 24, 48, and 72 h postsurgery between R and C groups. There was a weak evidence for a difference in the time to the first morphine administration after tracheal extubation to be longer for Group R than Group C (186.2 vs 81.0 min; 95% CI (−236.5, 26.2), P = 0.114). The incidence of nausea and vomiting were comparable between the groups. No signs or symptoms of local anesthetic toxicity were registered. Conclusions Contrary to our hypothesis, continuous ropivacaine wound infusion did not reduce morphine consumption, pain score values, or nausea and vomiting in children who underwent ASD closure with median sternotomy and mediastinal drain.