The Effect of Paravertebral Block With Dexamethasone on Intraoperative and Postoperative Analgesia in Children Undergoing Surgery for Coarctation of Aorta
Condition: Coarctation of Aorta
MeSH terms: Aortic Coarctation
Study type: Interventional
Phase: Phase 1

Summary: 
      Anesthetic management for surgery of aortic coarctation needs special care due to severe pain
      during lateral thoracotomy incision, the intraoperative hemodynamic instability related to
      skin incision at lateral thoracotomy, clamping and declamping of the aorta, needs of large
      doses of analgesia perioperative, needs of vasodilators. Also, postoperative care of the
      patients after repair is very important issue. The investigators will compare the effect of
      para-vertebral block with bupivacaine alone or with dexamethasone on Intra and postoperative
      analgesia.
    

Detailed description: 
      The patients will be divided randomly by sealed envelope into 2 equal groups. Group I (n=30)
      will receive paravertebral block with 0.5mg/kg bupivacaine 0.25% diluted with isotonic saline
      (total volume 15ml) and group II (n=30) will receive paravertebral block with 0.5mg/kg 0.25%
      bupivacaine and 0.1mg/kg dexamethasone.intraoperative fentanyl needs, Intra and postoperative
      hemodynamics and OPS pain scores will be recorded. Possible risks as hypertension will be
      treated by nitroglycerin infusion 0.5ug/kg/min or tachycardia (HR more than 20% than
      baseline) will be managed by additional doses of fentanyl 1-2ug/kg, bradycardia (20% decrease
      from the baseline) will be managed by atropine 0.02mg/kg. Also, the complications of
      paravertebral block as peridural and intravascular injection can be avoided by careful
      aspiration before injection and injection while visualization of the needle by U/S.
    

Intervention name(s): Dexamethasone; ultrasound; paravertebral block; Bupivacaine; isotonic saline
Intervention type(s): Drug; Device; Procedure; Drug; Other
Intervention description(s): Dexamethasone is commonly used in the perioperative period to reduce postoperative nausea and vomiting. Additionally, it has been reported to have analgesic effects.
The analgesic effect of epidural or perineural dexamethasone administration is not clear. Dexamethasone might have a local anesthetic effect on nerve by direct membrane action; The growth of ultrasound technology and, with it, our ability to visualize the pleura and other structures in and around the paravertebral space has fueled a tremendous increased interest in performing thoracic paravertebral blocks. These blocks may be used for acute pain control, as an adjunct to general anesthesia for peri-operative pain control and, in some practices, as the primary anesthetic; paravertebral block is an effective analgesic technique used in various types of surgery, trauma and chronic pain. it decreases postoperative pain and reduces opioid consumption which in turns improve postoperative pulmonary function hoping for early extubation.; it is an amino amide local anesthetic drug; sterile sodium chloride solution at physiological concentration (0.87%); used as diluting agent when added to local anesthetic drug
Other intervention name(s): decadron; marcain; normal saline
Intervention MeSH terms: Dexamethasone; Bupivacaine
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research