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PEDIATRIC ANESTHESIA

Postoperative Analgesia After Spinal Blockade in Infants and Children Undergoing Cardiac Surgery

Gregory B. Hammer, MD^*, Chandra Ramamoorthy, MBBS^*, Hong Cao, MD^*, Glyn D. Williams, MD^*, M. Gail Boltz, MD^*, Komal Kamra, MBBS^*, and David R. Drover, MD^*

Departments of *Anesthesia and Pediatrics, Stanford University Medical Center, California

Address correspondence and reprint requests to Gregory B. Hammer, MD, Department of Anesthesia, Room H3580, Stanford University Medical Center, 300 Pasteur Dr., Stanford, CA 94305-5115. Address e-mail to ham{at}Stanford.edu.

The aim of this prospective, randomized, controlled clinical trial was to define the opioid analgesic requirement after a remifentanil (REMI)-based anesthetic with spinal anesthetic blockade (SAB+REMI) or without (REMI) spinal blockade for open-heart surgery in children. We enrolled 45 patients who were candidates for tracheal extubation in the operating room after cardiac surgery. Exclusion criteria included age <3 mo and >6 yr, pulmonary hypertension, congestive heart failure, contraindication to SAB, and failure to obtain informed consent. All patients had an inhaled induction with sevoflurane and maintenance of anesthesia with REMI and isoflurane (0.3% end-tidal). In addition, patients assigned to the SAB+REMI group received SAB with tetracaine (0.5–2.0 mg/kg) and morphine (7 µg/kg). After tracheal extubation in the operating room, patients received fentanyl 0.3 µg/kg IV every 10 min by patient-controlled analgesia for pain score = 4. Pain scores and fentanyl doses were recorded every hour for 24 h or until the patient was ready for discharge from the intensive care unit. Patients in the SAB+REMI group had significantly lower pain scores (P = 0.046 for the first 8 h; P =0.05 for 24 h) and received less IV fentanyl (P = 0.003 for the first 8 h; P = 0.004 for 24 h) than those in the REMI group. There were no intergroup differences in adverse effects, including hypotension, bradycardia, highest PaCO₂, lowest pH, episodes of oxygen desaturation, pruritus, and vomiting.

This article has been cited by other articles:

				G. B. Hammer and B. Golianu Opioid analgesia in neonates following cardiac surgery. Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2007; 11(1): 47 - 58. [Abstract] [PDF]