A retrospective comparison of ropivacaine and 2-chloroprocaine continuous thoracic epidural analgesia for management of postthoracotomy pain in infants.

Muhly, Wallis T.; Gurnaney, Harshad G.; Kraemer, Francis W.; Ganesh, Arjunan; Maxwell, Lynne G.

Introduction Continuous thoracic epidural analgesia is useful in the management of infants following thoracotomy. Concerns about drug accumulation and toxicity limit the amount of amide local anesthetics that can be delivered. Continuous epidural infusions of the ester local anesthetic chloroprocaine result in little drug accumulation allowing for higher infusion rates. We retrospectively compared patients managed with 1.5% 2- chloroprocaine or 0.1% ropivacaine epidural infusions to determine if the increased infusion rate resulted in similar or improved analgesia. Methods This retrospective cohort comparison consisted of full term infants 6 months or younger who underwent thoracotomy for congenital lung lesion resection. Patients were included if they were managed with either a 1.5% 2-chloroprocaine (Group C) ( n = 26) or 0.1% ropivacaine (Group R) ( n = 28) infusion administered through a caudally placed thoracic epidural catheter. The primary outcome was morphine administration at 0-24 h. Results Patients were similar in age, weight, length of stay, epidural location and duration. There was weak evidence for a difference in morphine use in the first 24 h in Group C compared to Group R ( P = 0.08) but no difference 24-48 h. Group C was more commonly managed with ketorolac at 0-24 h ( P = 0.03) and 24-48 h ( P =< 0.01). Discussion The use of 2-chloroprocaine for continuous epidural infusion in infants following thoracotomy was not inferior to ropivacaine and there was weak evidence for a reduction in opioid consumption in the first 24 h postoperatively. However, the 2-chloroprocaine group was more likely to receive ketorolac.

EPIDURAL analgesia; EPIDURAL infusions; PEDIATRIC anesthesia; THORACOTOMY; PEDIATRIC surgery; PAIN management; LUNG surgery

Pediatric Anesthesia, 2015, Vol 25, Issue 11, p1162

1155-5645

Academic Journal

10.1111/pan.12745