Opioid-free anesthesia under single injection paravertebral block combined with sevoflurane for pediatric renal surgery:
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CLINICAL REPORT
Opioid‑free anesthesia under single injection paravertebral block combined with sevoflurane for pediatric renal surgery: a prospective observational pilot study Abdelghafour Elkoundi1 · Aziza Bentalha1 · Yasser Asmai1 · Alae El koraichi1 Received: 19 January 2020 / Accepted: 9 August 2020 © Japanese Society of Anesthesiologists 2020
Abstract Even though several studies have demonstrated the effectiveness of opioid free anesthesia (OFA) strategies in pediatric patients, OFA has not been studied in pediatric renal surgery. We, therefore, conducted a prospective observational pilot study on a total of 26 children to assess the feasibility and efficacy of using a single injection ultrasound-guided paravertebral block (PVB) at T10 level with 0.4 mL/kg bupivacaine 0.25% in combination with sevoflurane as an OFA technique in elective open renal surgery. A successful PVB (defined in terms of both hemodynamic change after the skin incision and the use of rescue analgesia) was observed in 25 children (96%). The interval between PVB and skin incision was 21 min [IQR (18–25)]. End tidal sevoflurane concentration was 2.1% [IQR (1.8–2.4)]. The median time between extubation and waking was 2.5 min [IQR (1–4)]. The median Face, Legs, Activity, cry, Consolability score in post-anesthesia care unit was 1.00 [IQR (0–2)]. Blood pressure falls were not significant at different measurement times. None of the patients had complications related to PVB, and only one patient had post-operative vomiting. PVB is an attractive method that can procure an effective OFA in combination with sevoflurane in pediatric renal surgery. Keywords Paravertebral block · Children · Opioids · Opioid-free anesthesia · Renal surgery
Introduction Opioid-free anesthesia (OFA) represents a step forward in anesthetic practice as it potentially spares the use of opioids by administrating nonopioid agents and adjuncts. The rationale to propose OFA is based on the aim to avoid the negative impact of intraoperative opioids on a patient’s post-operative outcomes. While a large number of studies has examined the efficacy of OFA in adult surgical populations, fewer studies are available in pediatric patients, including the use of peripheral nerve blocks in distal hand surgery [1], the use of dexmedetomidine in pediatric tonsillectomy [2], and the use of dexmedetomidine with ketorolac for pediatric tonsillectomy and adenotonsillectomy [3].
* Abdelghafour Elkoundi [email protected] 1
Pediatric Anesthesia and Critical Care Department, Children Hospital of Rabat, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, 10100 Rabat, Morocco
While these studies, involving minor and ambulatory surgeries, have by far shown consistently improved analgesia with opioid-free regimen, outcomes in specific types of surgery with more noxious stimulus are lacking in the pediatric literature. To our knowledge, there are no comprehensive reports of OFA for pediatric renal surgery, and the literature is still scarce on the clinically meani
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