Report of a case of ultrasound guided continuous thoracic paravertebral block for post thoracotomy analgesia in a child.

A six year old female child, weighing 13 kg was posted for patent ductus arteriosus ligation by a left lateral thoracotomy approach. The planned anesthetic was general anesthesia and placement of a continuous paravertebral block at the end of surgery for post operative analgesia. The patient was induced with propofol 30 mg i.v, fentanyl citrate 25 μg i.v and atracurium 7 mg i.v to facilitate endotracheal intubation, and maintained with sevoflurane in oxygen and air. After skin closure, ultrasound scanning in the transverse plane was done with 25 mm 6-13 MHz broadband linear array probe on a Sonosite micromaxx (Sonosite Inc, Bothwell, MA, USA) at the level of the skin incision just lateral to the thoracic spine. The transverse process of the vertebra, internal intercostal membrane, pleura and the wedge shaped paravertebral space were clearly identified. A 5 cm, 19 G Tuohy epidural needle was inserted inplane from the lateral to the medial side. 1.25 mg.kg-1 of 0.25% bupivacaine was injected in incremental aliquots and the thoracic paravertebral space was observed to distend with the pleura moving ventrally. A 0.63mm OD end hole catheter was inserted. After initial resistance, the catheter passed easily with slight rotation of the needle bevel. The catheter was tunneled and fixed with the tip 2 cm in the paravertebral space. The patient was extubated and shifted to the recovery room and an infusion of 0.125% bupivacaine was started at 0.25mg.kg-1.hr-1. Rescue analgesia consisted of pethidine 13 mg i.m and promethazine 6.5 mg i.m. The need for rescue analgesia was assessed by nursing staff not otherwise connected with the care of the patient. The patient was comfortable, slept well the night of surgery and did not receive any rescue analgesia during the 48 hr observation period.