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PEDIATRIC ANESTHESIA

Analgesia for Pediatric Thoracostomy Tube Removal

David A. Rosen, MD^*,, John L. Morris, BS^*, Kathleen R. Rosen, MD^*, Roberto C. Valenzuela, MD^*, Michele G. Vidulich, PA, Robert J. Steelman, MD, and Robert A. Gustafson, MD^,

Departments of *Anesthesia, Pediatrics, and Surgery, West Virginia University Children’s Hospital, West Virginia University, Morgantown, West Virginia

Address correspondence and reprint requests to David A. Rosen, MD, Department of Anesthesiology, 3618 Health Sciences Center, Box 9134, Morgantown, WV 26506-9134.

Eutectic mixture of local anesthetics (EMLA®; Astra Pharmaceuticals, Wayne, PA) has been shown to reduce the pain of blood draws in children. We investigated the use of EMLA® versus IV morphine for providing analgesia during chest tube removal (CTR) in children. One hundred twenty pediatric cardiothoracic surgery patients were enrolled. Patients were randomly assigned to receive either morphine (0.1 mg/kg up to 10 mg IV 30 min before CTR) or EMLA® cream (5 g per chest tube cutaneously 3 h before CTR). A single, trained observer rated the patient’s pain before, during, and after CTR using a 10-cm visual analog scale. The sites were evaluated for adverse effect. Methylhe-moglobin levels were monitored in infants. Before CTR, the pain scores of the children who received morphine were rated lower than those who received EMLA® (P < 0.01). During CTR, there was no difference in the pain score between the morphine or EMLA® group. The change from baseline pain score in the morphine group was significantly larger than in the EMLA® group (P < 0.01). We conclude that EMLA® is safe and useful for blunting the pain of CTR.

Implications: Chest tube removal is one of the most painful parts of the cardiothoracic surgical experience. This study compared EMLA® (Astra Pharmaceuticals, Wayne, PA) cream to morphine in providing pain relief for chest tube removal. EMLA® can be used as a useful means of controlling the pain of chest tube removal.

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