{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:36:32Z","timestamp":1787841392697,"version":"build-2784847793"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>The stripping of the densely innervated and inflamed parietal pleura in empyema during video-assisted thoracoscopic surgery (VATS) decortication can lead to significant pain and major postoperative respiratory compromise. Hence, we compared the analgesic efficacy of continuous epidural infusion versus local infiltration and systemic opioids in children undergoing VATS decortications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology:<\/jats:title>\n                    <jats:p>\n                      Following ethics approval and informed consent, forty patients from 1 to 12 years of age were randomized into two groups, Group E (epidural) and Group L (local infiltration) after induction of anesthesia. In Group E, a thoracic epidural catheter was inserted between T4 and T8. A bolus dose of 0.5 ml\/kg of 0.25% injection bupivacaine was given epidurally before incision. Postoperatively, the patients received epidural infusion with bupivacaine and fentanyl up to 48 h using an elastomeric balloon pump. In Group L, patients received local infiltration of bupivacaine (2 mg\/kg) and lignocaine (5 mg\/kg) at the port sites before incision and at the end of surgery. They also received injection tramadol 1 mg\/kg intravenously TDS with thrice daily postoperatively. The pain scores (Face, Legs, Activity, Cry, Consolability\/ Wong-Baker FACES scale) were assessed every 4 h on the 1\n                      <jats:sup>st<\/jats:sup>\n                      day and 6 h on the 2\n                      <jats:sup>nd<\/jats:sup>\n                      day. Injection diclofenac 1 mg\/kg intravenous was used as a rescue analgesic for pain scores more than 4. Side effects such as nausea, vomiting, constipation, and motor blockade were noted. Quantitative and categorical data were assessed using\n                      <jats:italic toggle=\"yes\">t<\/jats:italic>\n                      -test and Chi-square test, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The pain scores were lower in the epidural group than in the local infiltration group at 0, 4, and 20 h postoperatively (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.001, 0.01, and 0.038, respectively). Seventeen out of nineteen patients required rescue analgesia in the local infiltration group in the postoperative period as compared to five patients in the epidural group with a\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      value of 0.000081.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Epidural analgesia can be considered as an effective modality of reducing pain in patients undergoing VATS decortication for empyema in pediatric patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/sja.sja_659_17","type":"journal-article","created":{"date-parts":[[2018,3,8]],"date-time":"2018-03-08T23:57:08Z","timestamp":1520553428000},"page":"240-244","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":8,"title":["Comparison of analgesic efficacy and safety of continuous epidural infusion versus local infiltration and systemic opioids in video-assisted thoracoscopic surgery decortication in pediatric empyema patients"],"prefix":"10.4103","volume":"12","author":[{"given":"Priyanka Pradeep","family":"Karnik","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nandini Malay","family":"Dave","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhu","family":"Garasia","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20250920","first-page":"2838","article-title":"A study of paediatric empyema thoracis in a tertiary care hospital","volume":"3","author":"Ramireddy","year":"2016","journal-title":"Int J Comtemp Med Res"},{"key":"R2-20250920","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1136\/adc.88.10.842","article-title":"Empyema thoracis: Not time to put down the knife","volume":"88","author":"Spencer","year":"2003","journal-title":"Arch Dis Child"},{"key":"R3-20250920","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1016\/0003-4975(93)90933-9","article-title":"Pain management principles and anesthesia techniques for thoracoscopy","volume":"56","author":"Mulder","year":"1993","journal-title":"Ann Thorac Surg"},{"key":"R4-20250920","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1093\/bja\/aem065","article-title":"Audit of epidural analgesia in children undergoing 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Ann"},{"key":"R11-20250920","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1111\/j.1460-9592.2004.01553.x","article-title":"Clinical signs of infection during continuous postoperative epidural analgesia in children: The value of catheter tip culture","volume":"14","author":"Seth","year":"2004","journal-title":"Paediatr Anaesth"},{"key":"R12-20250920","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1097\/00000542-199611000-00005","article-title":"Clinical and bacteriologic survey of epidural analgesia in patients in the intensive care unit","volume":"85","author":"Darchy","year":"1996","journal-title":"Anesthesiology"}],"container-title":["Saudi Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01437113-201812020-00012","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:52:48Z","timestamp":1787838768000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01437113-201812020-00012"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4]]},"references-count":12,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.4103\/sja.sja_659_17","relation":{},"ISSN":["1658-354X","0975-3125"],"issn-type":[{"value":"1658-354X","type":"print"},{"value":"0975-3125","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,4]]}}}