Analgesic Quality Improvement in Paravertebral Blocks for Pediatric Nuss Procedure: An Exploratory Report on the Effects of Perineural Combined Glucocorticoids
Rebecca N Donham,1,* Evan Jin,2,* Michael G Caty,3 Donna-Ann Thomas,2 Claire Yuan,4 Kamren Hollingsworth,2 Xuewei Zhang,2 N David Yanez,5 Jinlei Li2,* 1Alabama College of Osteopathic Medicine, Dothan, AL, USA; 2Department of Anesthesiology, Yale University School of Medicine,...
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Dove Medical Press
2025-01-01
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| Series: | Journal of Pain Research |
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| author | Donham RN Jin E Caty MG Thomas DA Yuan C Hollingsworth K Zhang X Yanez ND Li J |
| author_facet | Donham RN Jin E Caty MG Thomas DA Yuan C Hollingsworth K Zhang X Yanez ND Li J |
| author_sort | Donham RN |
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| description | Rebecca N Donham,1,* Evan Jin,2,* Michael G Caty,3 Donna-Ann Thomas,2 Claire Yuan,4 Kamren Hollingsworth,2 Xuewei Zhang,2 N David Yanez,5 Jinlei Li2,* 1Alabama College of Osteopathic Medicine, Dothan, AL, USA; 2Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA; 3Department of Surgery, Yale University School of Medicine, New Haven, CT, USA; 4Harvard University, Cambridge, MA, USA; 5Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA*These authors contributed equally to this workCorrespondence: Jinlei Li, Department of Anesthesiology, Yale University School of Medicine, 20 York Street, New Haven, CT, 06510, USA, Tel +1 (475) 434-4038, Email jinlei.li@yale.eduPurpose: Pectus excavatum repair using the Nuss procedure is associated with significant postoperative opioid consumption even in the presence of a continuous thoracic paravertebral block.Patients and Methods: A CQI project was initiated by adding combined glucocorticoids as perineural adjuvants to continuous thoracic paravertebral block. An electronic health record review of patients undergoing Nuss procedures by a single surgeon at a major academic children’s hospital from June 2013 to December 2021 was performed with no patients excluded. The patients received pre-incision continuous bilateral T4 paravertebral blocks preoperatively either with plain ropivacaine (standard group, N = 34) or with a combination of dexamethasone sodium phosphate (DXP) and methylprednisolone acetate (MPA) in addition to ropivacaine (experimental group, N = 10). The primary outcome studied was postoperative opioid consumption measured by oral morphine milligram equivalents (MME).Results: A total of 44 patients were included in the final analysis. The experimental group had 72% lower postoperative opioid usage than the standard group during the hospitalization (p < 0.001) with comparable pain scores and hospital length of stay and no increase in wound dehiscence or other complications.Conclusion: The addition of dexamethasone sodium phosphate and methylprednisolone acetate to continuous paravertebral blocks significantly decreased postoperative opioid consumption while maintaining comfort pain scores.Keywords: Nuss procedure, paravertebral, dexamethasone, methylprednisolone acetate |
| format | Article |
| id | doaj-art-9c05dabc11e7496387b47b637291d752 |
| institution | Kabale University |
| issn | 1178-7090 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Pain Research |
| spelling | doaj-art-9c05dabc11e7496387b47b637291d7522025-01-27T18:05:33ZengDove Medical PressJournal of Pain Research1178-70902025-01-01Volume 1848949699663Analgesic Quality Improvement in Paravertebral Blocks for Pediatric Nuss Procedure: An Exploratory Report on the Effects of Perineural Combined GlucocorticoidsDonham RNJin ECaty MGThomas DAYuan CHollingsworth KZhang XYanez NDLi JRebecca N Donham,1,* Evan Jin,2,* Michael G Caty,3 Donna-Ann Thomas,2 Claire Yuan,4 Kamren Hollingsworth,2 Xuewei Zhang,2 N David Yanez,5 Jinlei Li2,* 1Alabama College of Osteopathic Medicine, Dothan, AL, USA; 2Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA; 3Department of Surgery, Yale University School of Medicine, New Haven, CT, USA; 4Harvard University, Cambridge, MA, USA; 5Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA*These authors contributed equally to this workCorrespondence: Jinlei Li, Department of Anesthesiology, Yale University School of Medicine, 20 York Street, New Haven, CT, 06510, USA, Tel +1 (475) 434-4038, Email jinlei.li@yale.eduPurpose: Pectus excavatum repair using the Nuss procedure is associated with significant postoperative opioid consumption even in the presence of a continuous thoracic paravertebral block.Patients and Methods: A CQI project was initiated by adding combined glucocorticoids as perineural adjuvants to continuous thoracic paravertebral block. An electronic health record review of patients undergoing Nuss procedures by a single surgeon at a major academic children’s hospital from June 2013 to December 2021 was performed with no patients excluded. The patients received pre-incision continuous bilateral T4 paravertebral blocks preoperatively either with plain ropivacaine (standard group, N = 34) or with a combination of dexamethasone sodium phosphate (DXP) and methylprednisolone acetate (MPA) in addition to ropivacaine (experimental group, N = 10). The primary outcome studied was postoperative opioid consumption measured by oral morphine milligram equivalents (MME).Results: A total of 44 patients were included in the final analysis. The experimental group had 72% lower postoperative opioid usage than the standard group during the hospitalization (p < 0.001) with comparable pain scores and hospital length of stay and no increase in wound dehiscence or other complications.Conclusion: The addition of dexamethasone sodium phosphate and methylprednisolone acetate to continuous paravertebral blocks significantly decreased postoperative opioid consumption while maintaining comfort pain scores.Keywords: Nuss procedure, paravertebral, dexamethasone, methylprednisolone acetatehttps://www.dovepress.com/analgesic-quality-improvement-in-paravertebral-blocks-for-pediatric-nu-peer-reviewed-fulltext-article-JPRnuss procedureparavertebraldexamethasonemethylprednisolone acetate |
| spellingShingle | Donham RN Jin E Caty MG Thomas DA Yuan C Hollingsworth K Zhang X Yanez ND Li J Analgesic Quality Improvement in Paravertebral Blocks for Pediatric Nuss Procedure: An Exploratory Report on the Effects of Perineural Combined Glucocorticoids Journal of Pain Research nuss procedure paravertebral dexamethasone methylprednisolone acetate |
| title | Analgesic Quality Improvement in Paravertebral Blocks for Pediatric Nuss Procedure: An Exploratory Report on the Effects of Perineural Combined Glucocorticoids |
| title_full | Analgesic Quality Improvement in Paravertebral Blocks for Pediatric Nuss Procedure: An Exploratory Report on the Effects of Perineural Combined Glucocorticoids |
| title_fullStr | Analgesic Quality Improvement in Paravertebral Blocks for Pediatric Nuss Procedure: An Exploratory Report on the Effects of Perineural Combined Glucocorticoids |
| title_full_unstemmed | Analgesic Quality Improvement in Paravertebral Blocks for Pediatric Nuss Procedure: An Exploratory Report on the Effects of Perineural Combined Glucocorticoids |
| title_short | Analgesic Quality Improvement in Paravertebral Blocks for Pediatric Nuss Procedure: An Exploratory Report on the Effects of Perineural Combined Glucocorticoids |
| title_sort | analgesic quality improvement in paravertebral blocks for pediatric nuss procedure an exploratory report on the effects of perineural combined glucocorticoids |
| topic | nuss procedure paravertebral dexamethasone methylprednisolone acetate |
| url | https://www.dovepress.com/analgesic-quality-improvement-in-paravertebral-blocks-for-pediatric-nu-peer-reviewed-fulltext-article-JPR |
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