Bilateral single bupivacaine injection ultrasound-guided paravertebral block facilitates early extubation and reduces perioperative opioids requirements in on-pump pediatric cardiac surgery

Background Paravertebral block (PVB) is a simple and easy technique with low incidence of complications and contraindications. The aim of the current study is to test the hypothesis that bilateral single-dose PVB may facilitate early extubation and reduce perioperative opioid requirements in pediatric patients submitted for open heart surgery by median sternotomy. Patients and methods A total of 70 pediatric patients submitted for open heart surgery by median sternotomy were randomized into two groups. The control group (n = 35) received 0.4 ml/kg normal saline with fentanyl 2 μg/ml, whereas for the bupivacaine group (n = 35) 0.4 ml/kg bupivacaine 0.25% with fentanyl 2 μg/ml was injected down each side of the paravertebral space. Heart rate, mean arterial blood pressure, perioperative opioid requirements, operating room extubation, time to extubation, postextubation PaO2, PaCO2, postoperative objective pain discomfort score, ICU length of stay, and postoperative complications were recorded. Results Heart rate and invasive mean arterial blood pressure were significantly lower in the bupivacaine group compared with the control group, after skin incision, after sternotomy, 15 min after cardiopulmonary bypass, and after the closure of sternum. Perioperative opioid requirements were significantly lower in the bupivacaine group than in the control group. The number of extubations in operating room was significantly higher, and time to extubation was significantly lower in the bupivacaine group compared with the control group. Postoperative pain score was significantly lower at 1, 2, and 6 h, and ICU length of stay was signifi cantly shorter in the bupivacaine group than in the control group. Conclusion Bilateral single bupivacaine dose PVB is a safe and effective technique that facilitates early extubation and provides good intraoperative and postoperative analgesia that results in reduced perioperative opioid requirements in pediatric patients submitted for open heart surgery by median sternotomy.