Ultrasound-guided thoracic epidural and paravertebral blocks for cholecystectomy in pediatric patients with a cyanotic heart disease: A randomized controlled study

Peer review under responsibility of Egyptian Society of Anesthesiologists.

Figures & data

igure 1 Intraoperative and postoperative changes in MAP in two studied groups. MAP: mean arterial pressure.

igure 2 Intraoperative and postoperative changes in HR in two studied groups. HR: heart rate.

igure 3 Intraoperative and postoperative changes in CVP in two studied groups. CVP: central venous pressure.

able 1 Children’s Hospital Eastern Ontario Pain Scale (CHEOPS) [9]. (Recommended for children 1–7 years old) – A score greater than 4 indicates pain.

Item	Behavioral		Definition
Cry	No cry	1	Child is not crying
	Moaning	2	Child is moaning or quietly vocalizing silent cry
	Crying	2	Child is crying, but the cry is gentle or whimpering
	Scream	3	Child is in a full-lunged cry; sobbing; may be scored with complaint or without complaint
Facial	Composed	1	Neutral facial expression
	Grimace	2	Score only if definite negative facial expression
	Smiling	0	Score only if definite positive facial expression
Child verbal	None	1	Child not talking
	Other complaints	1	Child complains, but not about pain, e.g., “I want to see mommy” of “I am thirsty”
	Pain complaints	2	Child complains about pain
	Both complaints	2	Child complains about pain and about other things, e.g., “It hurts; I want my mommy”
	Positive	0	Child makes any positive statement or talks about others things without complaint
Torso	Neutral	1	Body (not limbs) is at rest; torso is inactive
	Shifting	2	Body is in motion in a shifting or serpentine fashion
	Tense	2	Body is arched or rigid
	Shivering	2	Body is shuddering or shaking involuntarily
	Upright	2	Child is in a vertical or upright position
	Restrained	2	Body is restrained
Touch	Not touching	1	Child is not touching or grabbing at wound
	Reach	2	Child is reaching for but not touching wound
	Touch	2	Child is gently touching wound or wound area
	Grab	2	Child is grabbing vigorously at wound
	Restrained	2	Child’s arms are restrained
Legs	Neutral	1	Legs may be in any position but are relaxed; includes gentle swimming or separate-like movements
	Squirm/Kicking	2	Definitive uneasy or restless movements in the legs and/or striking out with foot or feet
	Drawn up/Tensed	2	Legs tensed and/or pulled up tightly to body and kept there
	Standing	2	Standing, crouching or kneeling
	Restrained	2	Child’s legs are being held down

able 2 Patients’ demographics and duration of anesthesia.

Item	Group A	Group B	P value
Age in (months)	40 ± 12	42 ± 10	0.553
Sex (m/f)	12/8	13 / 7	0.65
Body weight in (kg)	9.2 ± 4.5	10.3 ± 2.8	0.453
Duration of surgery in (min)	99.5 ± 15.6	98.1 ± 19.8	0.753
Number of patients with VSD	7	5	0.443
Number of patients with ASD	10	11
Number of patients with PDA	3	4

Data are expressed as mean ± SD or number.

Group A: epidural group.

Group B: paravertebral group.

P < 0.05 is considered significant.

m/f: male to female numbers.

igure 4 Postoperative changes in CHEOPS pain score in two studied groups. CHEOPS: Children’s Hospital Eastern Ontario Pain Scale.

able 3 The time for first analgesic requirement in hours and total fentanyl requirement μg/kg.

Items	Group (A)	Group (B)	P value
Time to 1st analgesic requirement (hr)	18.42 ± 2.04	17.30 ± 2.02	0.653
Postoperative fentanyl consumption μg/kg/24th	4.66 ± 2.09	4.93 ± 2.37	0.745

Data are expressed in Mean ± SD.

Group A: epidural group.

Group B: paravertebral group.

No significance: P > 0.05.

able 4 Oxygenation parameters and carbon dioxide parameters in two studied groups.

Item	Group A			Group B			P value
	PaO2 (mmHg)	SaO2 %	PaCO2 (mmHg)	PaO2 (mmHg)	SaO2 %	PaCO2 (mmHg)
Basal	96	97	35	100	98	34	0.73
After 15 min	96	96	34	97	97	34	0.71
After 45 min	60^⁎	90^⁎	40	86	96	35	0.003
After 75 min	63^⁎	90^⁎	40	86	96	35	0.003
At the end of surgery	57^⁎	89^⁎	42^⁎	88	96	34	0.001
1 h postop	65^⁎	92^⁎	42^⁎	98	97	33	0.000
4 h postop	65^⁎	92^⁎	42^⁎	100	98	34	0.000
8 h postop	74^⁎	94	40^⁎	101	98	34	0.012
16 h postop	79^⁎	95	41^⁎	102	98	35	0.041
24 h postop	96	97	37	98	98	34	0.62

Data are expressed in Mean ± SD.

Group A: epidural group.

Group B: paravertebral group.

Significance: P < 0.05.

PaO₂: arterial oxygen tension – SaO₂: arterial oxygen saturation – PaCO₂ arterial CO₂ tension.

#x204E; Significant between two groups.