Does epidural analgesia really enhance recovery in pediatric surgery patients?
link.springer.com shows its articles on its own site.
Read the article on link.springer.com ↗Article · Sep 2021 · 1 min read
In brief
In brief
Retrospective study of 209 pediatric surgical patients demonstrates that epidural anesthesia significantly reduces both pain scores and systemic opioid requirements during the first two postoperative days following laparotomy and thoracotomy. Findings support epidural use as an effective opioid-sparing strategy in pediatric enhanced recovery protocols.
Written by the GCMD Library team from the article.
Abstract
Purpose
We sought to determine the benefits of epidural anesthesia (EA) in pediatric surgical patients.
Methods
This study is a single-institution retrospective review of EA for pediatric patients undergoing thoracotomy or laparotomy from 2015 to 2020. Patients with recent or chronic opioid use were excluded. Urgent or emergent cases, patients with hemodynamic instability, or those with surgical complications that significantly impacted their post-operative course were also excluded. The primary objectives were comparison of pain scores and systemic opioid use between those patients with EA and those without EA.
Results
Epidural anesthesia was used in 151 (81.6%) laparotomies and 58 (77.3%) thoracotomies. EA use was associated with lower mean systemic opioid administration during the early post-operative period for laparotomy (POD#0—0.33 ± 0.3 oral morphine equivalents per kilogram (OME/Kg) with EA vs 0.93 ± 1.53, p < 0.001, POD#1—1.34 ± 1.79 OME/Kg with EA vs 2.61 ± 2.60, p < 0.001) and thoracotomy (POD#0—0.40 ± 0.37 OME/Kg with EA vs 0.68 ± 0.41, p = 0.008, POD#1—0.89 ± 0.86 OME/Kg with EA vs 2.02 ± 1.92, p < 0.001). There were no differences seen by POD#2. Average pain scores were significantly lower in patients with EA following laparotomy (POD#0—1.22 ± 0.99 with EA vs 1.75 ± 1.33, p = 0.008) and thoracotomy (POD#0—1.71 ± 1.13 with EA vs 2.40 ± 1.52, p = 0.04).
Conclusions
The use of EA in pediatric surgery patients was associated with lower pain scores despite lower systemic opioid requirements in the early post-operative period.