Paravertebral nerve block catheters using chloroprocaine in infants with prolonged mechanical ventilation for treatment of long-gap esophageal atresia.

摘要: BACKGROUND Infants with long-gap esophageal atresia (LGEA) undergo repeated thoracotomies for staged surgical repair known as the Foker process (FP). Associated prolonged mechanical ventilation results in exposure to high doses of opioids and benzodiazepines, weaning times ICU stays. AIM The aim this study was determine effectiveness short-term paravertebral nerve block (PVNB) catheters reducing opioid/benzodiazepine effects on clinical variables. METHODS medical records seventeen infants were retrospectively reviewed; 11 PVNB six without (CG). placed using ultrasound-guidance chloroprocaine infusions implemented ICU. Opioids benzodiazepines administered via protocol 5 days following Foker-I Foker-II. RESULTS Foker-I: Average reduction morphine midazolam consumption 36% (2.18 vs 3.40 mg·kg(-1) ·day(-1) ; P < 0.001) 31% (2.25 3.25 mg·kg(-1) P = 0.033), respectively, compared CG. Foker-II: 39% (3.19 5.27 mg·kg(-1) ) 38% (3.46 mg·kg(-1) 5.62; P < 0.001), respectively 24-h prior extubation: 50% (2.91 5.85 mg·kg(-1) ·24 h(-1) p = 0.023) 61% (2.27 5.83 mg·kg(-1) P = 0.004), Infusion wean time, (independence from opioid/midazolam infusions) extubation 5 days group 15 days CG (P = 0.005). Median stay (IQR) 40 days (34-45 days) patients 71 days (42-106 days) controls (P = 0.02). left an average 7 days there no complications associated blocks. CONCLUSION Short-term placement decreases opioid benzodiazepine exposure, undergoing LGEA small pilot study. Larger studies are warranted confirm results.