Multi-level intercostal block with bupivacaine helps in early extubation and shortens intensive care unit stay in pediatric patients undergoing thoracotomy

Materials and methods: all patients undergoing a thoracotomy in the department of pediatric cardiothoracic surgery from january 2010 to march 2011 were included in the study. the charts and records were reviewed. the demographics,co morbidities,procedure details,anesthetic management,icu stay,extubation time and administration of an intercostals block for all the patients were recorded and then included in a structured database. results: the total number of patients included in the study was 208. the majority of patients,201,were operated on for a cardiac cause while the remaining seven underwent surgery for a non- cardiac thoracic pathology. bupivacaine was administered to all patients in the dose of xxmg/kg. the block was done to include the space of entry and two spaces above and below. there were 115 males and 93 females. the mean age was 17.01 months (0.5-180 mo.) the mean weight was 7.07 kg (2-40 kg). the overall mortality was 6.25%. the average icu stay was 2.36 days (0-39). early extubation,defined as being within 24 hours of surgery,happened in 142 (68.2%) of the patients while 31 (15.3%) were extubated within 48 hours of surgery. the remaining patients required prolonged intubation and icu stays secondary to their underlying cardiac lesion and co morbidities. no patient in the early extubation period required re-intubation,and no patient who was extubated in the first 48 hours required prolonged ≥24 hours of narcotic analgesics. conclusions: multilevel intercostals block with bupivacaine helps in early extubation and shortens icu stays in pediatric patients undergoing a thoracotomy for cardiac and non cardiac etiologies.