RESUMEN
BACKGROUND AND OBJECTIVES: This prospective, randomized, single-blinded study evaluates the effectiveness of the ultrasound-guided bilateral thoracic paravertebral (BTPV) block for providing postoperative pain control in children undergoing the Nuss procedure. METHODS: Thirty American Society of Anesthesiologists I-II children with pectus excavatum, scheduled for the Nuss procedure, were enrolled at West China Hospital of Sichuan University. The patients were randomly allocated into the BTPV block group or the control group. In the BTPV group, 0.25% ropivacaine 0.5 mL/kg with 1:200,000 epinephrine was injected under ultrasound guidance on each side at the level of the fifth thoracic vertebra. Postoperative pain was evaluated in both groups for the first 48 hours. Total opioid administered and cumulative attempts on the patient/parent-controlled intravenous analgesia (PCA) pump were recorded. Postoperative negative behavioral changes in the children were evaluated on postoperative days 1, 7, and 30, respectively, using the posthospital behavior questionnaire. RESULTS: The pain scores were significantly reduced in the postanesthesia care unit and for the first 48 hours postoperatively in the BTPV group compared to the control group (P < 0.01). The sufentanil use in the postanesthesia care unit was significantly greater in the control group [mean (SD), 0.2 (0) mcg/kg] compared to the BTPV group [mean (SD), 0.05 (0.06) mcg/kg] (P < 0.01). The postoperative sufentanil use was significantly higher in the control group during the first 24 hours (P < 0.01). Numbers of attempts on the PCA pump were significantly greater in the control group (P < 0.01). The posthospital behavior questionnaire score was lower in the BTPV group on day 1, day 7, and 1 month, respectively (P < 0.01). CONCLUSIONS: Ultrasound-guided BTPV block provides improved postoperative analgesia for children undergoing the Nuss procedure as compared with intravenous PCA and decreases the incidence of postoperative behavioral disturbance.
Asunto(s)
Tórax en Embudo/cirugía , Bloqueo Nervioso/métodos , Dolor Postoperatorio/terapia , Ultrasonografía Intervencional/métodos , Adolescente , Presión Sanguínea , Niño , Preescolar , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Estudios Prospectivos , Método Simple CiegoRESUMEN
PURPOSE: Cities are expanding rapidly in middle-income countries, but their supply of acute care services is unknown. We measured acute care services supply in seven cities of diverse economic background. METHODS: In a cross-sectional study, we compared cities from two high-income (Boston, USA and Paris, France), three upper-middle-income (Bogota, Colombia; Recife, Brazil; and Liaocheng, China), and two lower-middle-income (Chennai, India and Kumasi, Ghana) countries. We collected standardized data on hospital beds, intensive care unit beds, and ambulances. Where possible, information was collected from local authorities. We expressed results per population (from United Nations) and per acute illness deaths (from Global Burden of Disease project). RESULTS: Supply of hospital beds where intravenous fluids could be delivered varied fourfold from 72.4/100,000 population in Kumasi to 241.5/100,000 in Boston. Intensive care unit (ICU) bed supply varied more than 45-fold from 0.4/100,000 population in Kumasi to 18.8/100,000 in Boston. Ambulance supply varied more than 70-fold. The variation widened when supply was estimated relative to disease burden (e.g., ICU beds varied more than 65-fold from 0.06/100 deaths due to acute illnesses in Kumasi to 4.11/100 in Bogota; ambulance services varied more than 100-fold). Hospital bed per disease burden was associated with gross domestic product (GDP) (R (2) = 0.88, p = 0.01), but ICU supply was not (R (2) = 0.33, p = 0.18). No city provided all requested data, and only two had ICU data. CONCLUSIONS: Urban acute care services vary substantially across economic regions, only partially due to differences in GDP. Cities were poor sources of information, which may hinder their future planning.