Paravertebral Blocks Cut Opioid Use After Peds Heart Surgery

Medscape

23-05-2025

In children undergoing cardiac surgery by thoracotomy, paravertebral blocks with ropivacaine reduced opioid consumption by nearly half within 24 hours after surgery compared with local anesthetic, while also reducing pain scores at 6 and 12 hours after the operation. However, the approach did not speed recovery from the procedure.
METHODOLOGY:
Researchers conducted a randomized double-blind trial to compare the efficacy of paravertebral blocks and local anesthetic for postoperative pain relief in children recovering from thoracotomies for cardiac surgery.
They enrolled 100 children aged 6-14 years (mean age, 7 years; 43% boys) with atrial or ventricular septal defects who were scheduled to undergo cardiac surgery with cardiopulmonary bypass via thoracotomy at a Chinese hospital between March and August 2024.
All patients received a paravertebral block and wound infiltration. They were randomly assigned to one of two groups: One received a paravertebral block at the T4-T5 level with 3 mg/kg of 0.375% ropivacaine after surgery, with saline as a placebo for wound infiltration (n = 50). The other received local wound infiltration with the same dosage of ropivacaine bilaterally at the incision and drainage sites, with saline as a placebo for the block (n = 50).
The primary outcome was total opioid (sufentanil) consumption within 24 hours after surgery.
Pain intensity was self-reported at 6-hour intervals using the Faces Pain Scale–Revised (FPS-R) for children, scored from 0 (no pain) to 10 (severe pain).
TAKEAWAY:
Children who received paravertebral blocks consumed significantly lower sufentanil within 24 hours after surgery than those who received local anesthetic wound infiltration (mean consumption, 0.3 vs 0.6 μg/kg; P = .004).
= .004). Pain scores were lower among children who received paravertebral blocks than among those who received local anesthetic wound infiltration, with the most significant and clinically meaningful reduction observed at 6 hours after surgery (mean FPS-R score, 1.7 vs 3.3; P < .001 ). The scores were comparable between groups at 24 hours.
< .001 ). The scores were comparable between groups at 24 hours. The two groups showed no significant differences in the duration of postoperative mechanical ventilation, stay in the intensive care unit, or hospitalization.
No patients in either group experienced a paravertebral hematoma, vascular or neurologic injuries, or hypotension. The rates of postoperative nausea and vomiting were similar between the two groups.
IN PRACTICE:
'Paravertebral blocks reduced sufentanil consumption and pain during the initial 18 hours after pediatric cardiac surgery but did not speed recovery or shorten ICU stays or the duration of hospitalization,' the researchers reported.
SOURCE:
This study was led by Jingfei Guo and Yuan Jia, from Fuwai Hospital in Beijing, China. It was published online on May 14, 2025, in Regional Anesthesia & Pain Medicine .
LIMITATIONS:
Sufentanil was administered by nurses, which may not have been titrated precisely as per the needs of the patient. The researchers did not differentiate between pain evoked by movement, which is usually worse, from pain at rest.
DISCLOSURES:
This study received support from National High-Level Hospital Clinical Research Funding from Fuwai Hospital. The authors declared having no competing interests.