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BJA Advance Access published online on March 15, 2007
British Journal of Anaesthesia, doi:10.1093/bja/aem055
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Postoperative analgesia with intravenous fentanyl PCA vs epidural block after thoracoscopic pectus excavatum repair in children

D. Butkovic1,*, S. Kralik1, M. Matolic1, M. Kralik2, S. Toljan1 and L. Radesic1

1 Children's Hospital Zagreb, Department of Anaesthesiology, Reanimatology and Intensive Care, Zagreb, Croatia
2 Clinical Hospital Centre Rebro, Clinical Institute of Diagnostic and Interventional Radiology, Zagreb, Croatia

* Corresponding author: Children's Hospital Zagreb, Department of Anaesthesiology, Reanimatology and Intensive Care, Klaiceva 16, 10000 Zagreb, Croatia. E-mail: diana.butkovic1{at}zg.htnet.hr

Background: The aim of this prospective, randomized trial was to compare analgesia, sedation, and cardiorespiratory function in children after thoracoscopic surgery for pectus excavatum repair, using two types of analgesia—epidural block with bupivacaine plus fentanyl vs patient-controlled analgesia (PCA) with fentanyl.

Methods: Twenty-eight patients scheduled for thoracoscopic pectus excavatum surgery were randomly assigned to receive either thoracic epidural block or i.v. PCA for postoperative analgesia. Pain was assessed using a visual-analogue scale (VAS). The Ramsay sedation score, arterial pressure, ventilatory frequency, and heart rate were also measured, and blood gas analysis was performed regularly during the first 48 h after surgery.

Results: A significant decrease in the VAS pain score, Ramsay sedation score, heart rate ventilatory frequency, systolic and diastolic blood pressure, and PaCO2, and a significant increase in PaO2 and oxygen saturation were found over time. Patients in the PCA group had significantly higher PaCO2 values. In addition, a significantly slower decline of systolic blood pressure and heart rate, and faster recovery of PaCO2 were found in PCA patients than in patients with epidural block.

Conclusions: I.V. fentanyl PCA is as effective as thoracic epidural for postoperative analgesia in children after thoracoscopic pectus excavatum repair. Bearing in mind the possible complications of epidural catheterization in children, the use of fentanyl PCA is recommended.

Keywords: analgesia, patient controlled; analgesic techniques, epidural; analgesics opioid, fentanyl; children; procedure, Nuss


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Is fentanyl PCA really a better choice than thoracic epidural in children?
François Semjen, et al.
British Journal of Anaesthesia, 3 Apr 2007 [Full text]

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