Key result
Regional anesthesia (thoracic epidural and caudal) significantly reduced postoperative pain scores compared to intravenous analgesia in pediatric cardiac surgery, with thoracic epidural providing the lowest pain scores at 12 hours.
Why the study?
Studies comparing thoracic epidural and caudal analgesia alongside general anaesthesia in paediatric cardiac surgery are limited.
Does regional anaesthesia (caudal or thoracic epidural) improve post-operative pain scores in children undergoing elective cardiac surgery compared to intravenous analgesia?
RCT (n=90)
Double-blind
Computer generated block randomisation
No
Does regional anaesthesia (caudal or thoracic epidural) improve post-operative pain scores in children undergoing elective cardiac surgery compared to intravenous analgesia?
Thoracic epidural analgesia combined with general anesthesia significantly reduces post-operative pain, duration of mechanical ventilation, and ICU stay in pediatric patients undergoing cardiac surgery compared to caudal or intravenous analgesia.
Thoracic epidural may shorten ventilation and ICU stay versus caudal or IV analgesia in children; leaves open optimal technique and safety in larger trials.
Introduction:Regional anaesthesia combined with general anaesthesia reduces stress response to surgery, duration of ventilation, intensive care unit (ICU) stay and promotes early recovery. Studies on thoracic epidural, caudal analgesia along with general anaesthesia (GA) in paediatric cardiac surgery are limited hence we aimed to compare efficacy and safety of caudal, thoracic epidural and intravenous analgesia in paediatric cardiac surgery. Methodology: This study was conducted in the Department of Anaesthesiology in a tertiary care teaching hospital in southern India from February 2019 to December 2019. 90 children were randomised into group A, group B, group C. Children in group A received caudal analgesia along with GA. Group B children received thoracic epidural along with GA. Group C patients received intravenous analgesia along with GA. Rescue analgesia 1 mcg/kg fentanyl given in all 3 groups if pain score is more than 4. Primary outcome assessed was post-op pain scores. Secondary outcome assessed was duration of ventilation, duration of intensive care unit stay. Results: All patients were comparable in terms of age, sex, weight, mean RACHS score, baseline heart rate and blood pressure. Pain scores were significantly lower in thoracic epidural group compared to other two grou ps. Duration of ventilation was lower in thoracic epidural group (91.17± 43.85) minutes and caudal (199.6 ± 723.59) minutes compared to intravenous analgesia groups (436.37 ± 705.51) minutes. Duration of ICU stay was significantly low in thoracic epidural group (2.73 ± 0.69) days compared to caudal (3.7 ± 2.8) and intravenous analgesia groups (4.33 ± 0.920). We didn’t have any complications like hematoma, transient or permanent neurological sequelae in regional anesthesia groups. Conclusion: Regional anaesthesia along with general anaesthesia was more effective in pain relief than intravenous analgesia with general anaesthesia in paediatric cardiac surgery.
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Vakamudi et al. (2020) conducted an RCT in Pediatric cardiac surgery (n=90). Thoracic epidural and caudal analgesia vs. Intravenous analgesia (fentanyl) was evaluated on Post-operative pain scores at 12 hours (FLACC scale) (p=0.001). Regional anesthesia (thoracic epidural and caudal) significantly reduced postoperative pain scores compared to intravenous analgesia in pediatric cardiac surgery, with thoracic epidural providing the lowest pain scores at 12 hours.
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