Analgesic Quality Improvement in Paravertebral Blocks for Pediatric Nuss Procedure: An Exploratory Report on the Effects of Perineural Combined Glucocorticoids.

PURPOSE: 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.