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Intravenous Morphine Infusion versus Thoracic Epidural Infusion of Ropivacaine with Fentanyl after the Ravitch Procedure—A Single-Center Cohort Study

Objective. To compare the efficacy of analgesia with intravenous infusion of morphine and thoracic epidural infusion of ropivacaine with fentanyl in pediatric patients after the Ravitch procedure. Methods. Postoperative analgesia was achieved by intravenous morphine infusion with a dose of 0.02–0.06...

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Autores principales: Fenikowski, Dariusz, Tomaszek, Lucyna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9517208/
https://www.ncbi.nlm.nih.gov/pubmed/36141560
http://dx.doi.org/10.3390/ijerph191811291
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author Fenikowski, Dariusz
Tomaszek, Lucyna
author_facet Fenikowski, Dariusz
Tomaszek, Lucyna
author_sort Fenikowski, Dariusz
collection PubMed
description Objective. To compare the efficacy of analgesia with intravenous infusion of morphine and thoracic epidural infusion of ropivacaine with fentanyl in pediatric patients after the Ravitch procedure. Methods. Postoperative analgesia was achieved by intravenous morphine infusion with a dose of 0.02–0.06 mg/kg per hour (intravenous group, n = 56) or thoracic epidural infusion of 0.2% ropivacaine and fentanyl 5 µg/mL with a flow rate of 0.1 mL/kg per hour (epidural group, n = 40). Furthermore, the multimodal pain management protocol included paracetamol, non-steroidal anti-inflammatory drugs, and metamizole as a rescue drug. The primary outcomes included pain scores (according to the Numerical Rating Scale, range 0–10), while the secondary outcomes included consumption of the rescue drug, anxiety, postoperative side effects, and patient satisfaction. The observation period lasted from postoperative day 0 to postoperative day 3. Results. Median average and maximal pain scores at rest, during deep breathing, and coughing were significantly lower in the intravenous group compared to the epidural group (p < 0.05). The effect size was medium (Cohen’s d ranged from 0.5 to 0.7). Patients receiving morphine required significantly lower numbers of metamizole doses than in the epidural group (median 1 vs. 3; p = 0.003; Cohen’s d = 0.6). Anxiety, postoperative side effects, and patient satisfaction were similar in both groups (p > 0.05). Conclusions. An intravenous infusion of morphine may offer better postoperative analgesia than a thoracic epidural infusion of ropivacaine with fentanyl.
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spelling pubmed-95172082022-09-29 Intravenous Morphine Infusion versus Thoracic Epidural Infusion of Ropivacaine with Fentanyl after the Ravitch Procedure—A Single-Center Cohort Study Fenikowski, Dariusz Tomaszek, Lucyna Int J Environ Res Public Health Article Objective. To compare the efficacy of analgesia with intravenous infusion of morphine and thoracic epidural infusion of ropivacaine with fentanyl in pediatric patients after the Ravitch procedure. Methods. Postoperative analgesia was achieved by intravenous morphine infusion with a dose of 0.02–0.06 mg/kg per hour (intravenous group, n = 56) or thoracic epidural infusion of 0.2% ropivacaine and fentanyl 5 µg/mL with a flow rate of 0.1 mL/kg per hour (epidural group, n = 40). Furthermore, the multimodal pain management protocol included paracetamol, non-steroidal anti-inflammatory drugs, and metamizole as a rescue drug. The primary outcomes included pain scores (according to the Numerical Rating Scale, range 0–10), while the secondary outcomes included consumption of the rescue drug, anxiety, postoperative side effects, and patient satisfaction. The observation period lasted from postoperative day 0 to postoperative day 3. Results. Median average and maximal pain scores at rest, during deep breathing, and coughing were significantly lower in the intravenous group compared to the epidural group (p < 0.05). The effect size was medium (Cohen’s d ranged from 0.5 to 0.7). Patients receiving morphine required significantly lower numbers of metamizole doses than in the epidural group (median 1 vs. 3; p = 0.003; Cohen’s d = 0.6). Anxiety, postoperative side effects, and patient satisfaction were similar in both groups (p > 0.05). Conclusions. An intravenous infusion of morphine may offer better postoperative analgesia than a thoracic epidural infusion of ropivacaine with fentanyl. MDPI 2022-09-08 /pmc/articles/PMC9517208/ /pubmed/36141560 http://dx.doi.org/10.3390/ijerph191811291 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Fenikowski, Dariusz
Tomaszek, Lucyna
Intravenous Morphine Infusion versus Thoracic Epidural Infusion of Ropivacaine with Fentanyl after the Ravitch Procedure—A Single-Center Cohort Study
title Intravenous Morphine Infusion versus Thoracic Epidural Infusion of Ropivacaine with Fentanyl after the Ravitch Procedure—A Single-Center Cohort Study
title_full Intravenous Morphine Infusion versus Thoracic Epidural Infusion of Ropivacaine with Fentanyl after the Ravitch Procedure—A Single-Center Cohort Study
title_fullStr Intravenous Morphine Infusion versus Thoracic Epidural Infusion of Ropivacaine with Fentanyl after the Ravitch Procedure—A Single-Center Cohort Study
title_full_unstemmed Intravenous Morphine Infusion versus Thoracic Epidural Infusion of Ropivacaine with Fentanyl after the Ravitch Procedure—A Single-Center Cohort Study
title_short Intravenous Morphine Infusion versus Thoracic Epidural Infusion of Ropivacaine with Fentanyl after the Ravitch Procedure—A Single-Center Cohort Study
title_sort intravenous morphine infusion versus thoracic epidural infusion of ropivacaine with fentanyl after the ravitch procedure—a single-center cohort study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9517208/
https://www.ncbi.nlm.nih.gov/pubmed/36141560
http://dx.doi.org/10.3390/ijerph191811291
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