Trial reportPain research & management2026
Noninferiority of Ultrasound-Guided Modified Intercostal Block to Traditional Approach for Analgesia After Minimally Invasive Repair of Pectus Excavatum in Children: A Randomized Trial.
Trial report in Pain research & management, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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6 authors.
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Abstract
backgroundFor pediatric pectus excavatum, the standard treatment is minimally invasive repair of pectus excavatum (MIRPE). A major challenge, however, is the severe postoperative pain. Although ultrasound-guided intercostal nerve block (UINB) offers effective analgesia, the technique's complexity and associated safety concerns are significant barriers, deterring its routine use. Modified intercostal nerve block (MINB) is effective in adult thoracic surgery but unvalidated in pediatric MIRPE.
objectiveTo evaluate MINB's noninferiority to UINB for postoperative analgesia and safety in children undergoing MIRPE.
designSingle-center randomized noninferiority trial.
methodsSeventy-six ASA I-II pediatric patients (8-18 years) scheduled for single-bar MIRPE were 1:1 randomized to the MINB or UINB group. Primary outcome includes 24-h postoperative coughing visual analog scale (VAS) score (noninferiority margin Δ = 1.0). Secondary outcomes include resting/coughing VAS scores at 3, 6, 9, 12, 24, and 48 h postoperatively; procedure duration; local anesthetic dose; needle complications; opioid consumption; rescue analgesia; and adverse events.
resultsThe mean difference in 24-h coughing VAS (MINB-UINB) score was -0.02 (95% CI: -0.85 to 0.80), confirming noninferiority of MINB (upper 95% CI limit 0.80 < noninferiority margin Δ = 1.0). MINB reduced procedure time by 65% (4.6 ± 1.3 vs. 13.2 ± 1.6 min; p < 0.001), decreased ropivacaine dose by 19% (50.0 ± 0.0 vs. 61.9 ± 4.6 mg; p < 0.001), shortened anesthesia duration (119.6 ± 18.3 vs. 131.8 ± 14.6 min; p = 0.002), and eliminated vascular injuries (0% vs. 16.2%; p = 0.025). All other outcomes demonstrated no statistically significant differences in the comparisons between the groups (p > 0.05).
conclusionsFor children undergoing single-bar MIRPE, MINB provides noninferior analgesia to UINB with critical advantages: 65% faster placement, 19% lower ropivacaine dose, reduced anesthesia duration, and elimination of vascular injuries. These findings suggest that MINB offers a valuable alternative to UINB for post-MIRPE analgesia, as it appears to provide a more favorable balance between safety and efficiency. TRAIL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2200057961.
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