Key result
Caudal epidural analgesia reduces postoperative pain ~46% vs intravenous analgesia in pediatric open-heart surgery.
Why the study?
Regional anesthesia may attenuate adverse physiological stress responses associated with cardiothoracic surgery, motivating a comparison of caudal epidural versus intravenous analgesia in pediatric open-heart surgery.
Does general anesthesia with caudal epidural analgesia improve hemodynamic response and postoperative pain compared to general anesthesia with intravenous analgesia in pediatric patients undergoing open-heart surgery?
RCT (n=50)
sealed envelope technique
No
Does general anesthesia with caudal epidural analgesia improve hemodynamic response and postoperative pain compared to general anesthesia with intravenous analgesia in pediatric patients undergoing open-heart surgery?
Absolute Event Rate: 2.5% vs 4.6%
p-value: p=0.004
In pediatric patients undergoing open-heart surgery, combining general anesthesia with caudal epidural analgesia improves hemodynamic stability and reduces postoperative pain compared to intravenous analgesia.
Favors caudal epidural for lower pain after pediatric open-heart surgery; extends RCT evidence for regional techniques in congenital cardiac procedures.
Context: Regional anesthesia may attenuate adverse physiological stress responses associated with cardiothoracic surgery. In this study, hemodynamic stress response at the different time of surgical stimuli was compared between patients receiving general anesthesia (GA) along with caudal epidural analgesia with GA with intravenous analgesia in pediatric population undergoing open-heart surgery. Aims: This study aims to compare the hemodynamic response at the different time of surgical stimuli and postoperative pain score, in pediatric patients undergoing open-heart procedures. Settings and Design: We designed a prospective randomized controlled trial to study hemodynamic effects between Group I and Group II. Fifty patients were randomly allocated equally into Group I (GA + caudal epidural) and Group II (GA + intravenous analgesia) by sealed envelope technique. Subjects and Methods: After obtaining approval from Institutional Ethical Committee, this prospective study was conducted in 50 American Society of Anesthesiologist Classes II and III pediatric patients aged between 1 and 12 years posted for cardiac surgery in our institution. Statistical Analysis: ANOVA, two-way ANOVA, and Student's test. Results: The heart rate, systolic blood pressure, diastolic blood pressure and mean blood pressure variations were compared between Groups I and II at different time intervals. The variations were found to be significantly higher at the time of skin incision and 2 min after skin incision in Group II as compared to Group I. Pain score was compared between the groups and was found to be significantly lower with Group I (2.5 ± 1.2) as compared to Group II (4.6 ± 1.7), P = (0.004). Conclusions: Caudal analgesia with GA (Group I) was found to have better hemodynamic control and significantly better postoperative pain relief in the first 24 h after awakening.
No takes yet. Share an insight, caveat, or question.
Samantaray et al. (2019) conducted an RCT in open-heart surgery (n=50). General anesthesia with caudal epidural analgesia vs. General anesthesia with intravenous analgesia was evaluated on postoperative pain score (p=0.004). General anesthesia with caudal epidural analgesia resulted in significantly lower postoperative pain scores compared to intravenous analgesia (2.5 vs 4.6, P=0.004) in pediatric open-heart surgery.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: