Somatic paravertebral block decreases opioid requirements in children undergoing appendectomy

Purpose

Somatic paravertebral block (SPVB) appears to provide effective and prolonged nerve block in children; however, study of its use in this population is limited. We compared SPVB with no block in children undergoing appendectomy.

Methods

Thirty-six children aged 3-16 yr undergoing open appendectomy were involved in this prospective randomized controlled study. Anesthesia was induced with propofol and maintained with isoflurane in N₂O/oxygen. All subjects received fentanyl, acetaminophen and ketorolac during anesthesia. Group I (SPVB) subjects received a right SPVB at T₁₁, T₁₂, and L₁ using 0.2% ropivacaine 0.25 mL·kg^?1 with epinephrine 1:200,000 preoperatively. Group II (Control) had only bandaids applied to skin. Both groups were given morphine 0.05 mg·kg^?1 iv every 2 hr if pain scores reached 5/10 on a visual analogue scale. Acetaminophen was administered postoperatively every 6 hr to both groups. Time to first dose of morphine, total dose of morphine in 24 hr, and any adverse effects up to 24 hr after surgery were recorded.

Results

Group I (SPVB) subjects required significantly less morphine than Group II (Control) patients (0.12 ± 0.07 vs 0.34 ± 0.15 mg·kg^?1, respectively; P < 0.001), and time to their first dose was significantly longer (7.1 ± 4.4 vs 2.5 ± 1.6 hr, respectively; P < 0.001). Incidence of vomiting was 11% with Group I and 27% with Group II (P = 0.21). No other adverse effects were observed in either group.

Conclusions

In children undergoing appendectomy, SPVB provides better pain relief than no block and reduces opioid requirements. Side effects were not statistically different between groups.