Interpleural bupivacaine and intravenous oxycodone for pain treatment after thoracotomy in children

Hannu Kokki, MD, PhD, Merja Laisalmi, MD, Kari Vanamo, MD, PhD

Abstract


Introduction: The results of studies exploring the efficacy of interpleural analgesia in children post-thoracotomy have frequently been inconclusive. In this pilot study, we have evaluated the efficacy and safety of interpleural bupivacaine and intravenous (IV) oxycodone in pain treatment after thoracotomy in 10 generally healthy children, aged 10 months to 12 years, with patent ductus arteriosus who underwent thoracotomy.
Methods: After surgery, all 10 children were given ibuprofen 10 mg/kg rectally every six hours. The first dose of interpleural bupivacaine (2 mg/kg) was given with epinephrine at the end of surgery, and thereafter plain bupivacaine (1 mg/kg) was given every two hours if the pain score was 4 or higher on an 11-point numeric rating scale (0 = no pain, 10 = worst possible pain). For rescue analgesia, children were provided oxycodone 0.1 mg/kg IV if pain was not relieved sufficiently with ibuprofen and bupivacaine. Vital signs, pain scores, and all adverse effects were monitored continuously for 24 hours.
Results: All 10 children needed both interpleural bupivacaine and IV oxycodone. The number of bupivacaine doses ranged between three and 10 (mean = 6.1, SD = 2.3), and the number of oxycodone doses ranged between one and 12 (mean = 6.0, SD = 3.6). No cases of low respiratory rate or low peripheral oxygen saturation or any serious adverse events were recorded.
Conclusion: Scheduled nonopioid analgesic (ibuprofen) with interpleural bupivacaine did not provide sufficient analgesia for post-thoracotomy pain in young children. IV oxycodone was found to be an effective and safe opioid supplement to the pain regimen.


Keywords


oxycodone, intravenous, bupivacaine, interpleural, ibuprofen, rectal, thoracotomy, pain, child

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References


Katz J, Jackson M, Kavanagh BP, et al.: Acute pain after thoracic surgery predicts long-term post-thoracotomy pain. Clin J Pain. 1996; 12(1): 50-55.

Kalso E, Perttunen K, Kaasinen S: Pain after thoracic surgery. Acta Anaesthesiol Scand. 1992; 36(1): 96-100.

Gottschalk A, Cohen SP, Yang S, et al.: Preventing and treating pain after thoracic surgery. Anesthesiology. 2006; 104(3): 594-600.

Reiestad F, Stromskag KE: Interpleural catheter in the management of postoperative pain. A preliminary report. Reg Anesth. 1986; 11: 89-91.

McIlvaine WB, Chang JH, Jones M: The effective use of intrapleural bupivacaine for analgesia after thoracic and subcostal incisions in children. J Pediatr Surg. 1988; 23(12): 1184-1187.

Rosenberg PH, Scheinin BM, Lepantalo MJ, et al.: Continuous intrapleural infusion of bupivacaine for analgesia after thoracotomy. Anesthesiology. 1987; 67(5): 811-813.

Pöyhiä R: Opioids in anaesthesia: A questionnaire survey in Finland. Eur J Anaesthesiol. 1994; 11(3): 221-230.

Olkkola KT, Hamunen K, Seppälä T, et al.: Pharmacokinetics and ventilatory effects of intravenous oxycodone in postoperative children. Br J Clin Pharmacol. 1994; 38(1): 71-76.

Kalso E, Pöyhiä R, Onnela P, et al.: Intravenous morphine and oxycodone for pain after abdominal surgery. Acta Anaesthesiol Scand. 1991; 35(7): 642-646.

Pöyhiä R, Vainio A, Kalso E: A review of oxycodone’s clinical pharmacokinetics and pharmacodynamics. J Pain Symptom Manage. 1993; 8(2): 63-67.

Kokki H, Lintula H, Vanamo K, et al.: Oxycodone vs placebo in children with undifferentiated abdominal pain—a randomized, double blind clinical trial of the effect of analgesia on diagnostic accuracy. Arch Pediatr Adolesc Med. 2005; 159(4): 320-325.

El-Tahtawy A, Kokki H, Reidenberg BE: Population pharmacokinetics of oxycodone in children 6 months to 7 years old. J Clin Pharmacol. 2006; 46(4): 433-442.

Maunuksela EL, Olkkola KT, Korpela R: Measurement of pain in children with self-reporting and behavioral assessment. Clin Pharmacol Ther. 1987; 42: 137-141.

Scheinin B, Lindgren L, Rosenberg PH: Treatment of postthoracotomy pain with intermittent instillations of intrapleural bupivacaine. Acta Anaesthesiol Scand. 1989; 33(2): 156-159.

Silomon M, Claus T, Huwer H, et al.: Interpleural analgesia does not influence postthoracotomy pain. Anesth Analg. 2000; 91(1): 44-50.

McIlvaine WB, Knox RF, Fennessey PV, et al.: Continuous infusion of bupivacaine via intrapleural catheter for analgesia after thoracotomy in children. Anesthesiology. 1988; 69(2): 261-264.

Tobias JD, Martin LD, Oakes L, et al.: Postoperative analgesia following thoracotomy in children: Interpleural catheters. J Pediatr Surg. 1993; 28(11): 1466-1470.

Semsroth M, Plattner O, Horcher E: Effective pain relief with continuous intrapleural bupivacaine after thoracotomy in infants and children. Paediatr Anaesth. 1996; 6(4): 303-310.

Berde CB: Toxicity of local anesthetics in infants and children. J Pediatr. 1993; 122(5 Pt 2): S14-S20.

Tucker GT: Pharmacokinetics of local anaesthetics. Br J Anaesth. 1986; 58(7): 717-731.

Kokki H, Rasanen I, Reinikainen M, et al.: Pharmacokinetics of oxycodone after intravenous, buccal, intramuscular and gastric administration in children. Clin Pharmacokinetics. 2004; 43(9): 613-622.

Kokki H, Salonen A: Comparison of pre- and postoperative administration of ketoprofen for analgesia after tonsillectomy in children. Paediatr Anesth. 2002; 12(2): 162-167.

Lintula H, Kokki H, Vanamo K: Single-blind randomized clinical trial of laparoscopic versus open appendicectomy in children. Br J Surg. 2001; 88(4): 510-514.

Nagyova B, Dorrington KL, Gill EW, et al.: Comparison of the effects of sub-hypnotic concentrations of propofol and halothane on the acute ventilatory response to hypoxia. Br J Anaesth. 1995; 75(6): 713-718.

Ward DS, Karan S: Effects of pain and arousal on the control of breathing. J Anesth. 2002; 16(3): 216-221.

Kotiniemi LH, Ryhänen PT, Moilanen IK: Behavioural changes in children following day-case surgery: A 4-week follow-up of 551 children. Anaesthesia. 1997; 52(10): 970-976.




DOI: https://doi.org/10.5055/jom.2006.0043

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