Addition of Local Anesthetic Epidural Infusion Catheter to Intravenous Opioid Analgesia for Postoperative Pain Control in Children Undergoing Video Assisted Thoracoscopic Surgery (VATS) |
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| Institution: | 1. Department of Anesthesiology & Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center & Children''s Hospital, Hershey, PA;2. Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA;1. Department of Nursing, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China;2. Department of Otolaryngology, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China;3. Information Department, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China;4. Department of Nutriology, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China;1. Mercy Medical Center, Owings Mills, Baltimore, MD;2. Vanderbilt University Medical Center, Nashville, TN;3. Johns Hopkins Hospital, Baltimore, MD;4. Stony Brook University Hospita, Stony Brook, NY;5. Evansville Surgery Center, Evansville, Indiana;1. Surgical Nursing Department, Kumluca Faculty of Health Sciences, Akdeniz University, Kumluca-Antalya, Turkey;2. Nursing Department, Semra ve Vefa Faculty of Health Sciences, Hac? Bekta?i Veli University, Nev?ehir, Turkey;1. College of Nursing, University of Kentucky, Lexington, KY;2. Inova System Nursing Professional Development, Inova, Falls Church, VA;3. Department of Nursing Practice, Clinical and Patient Education, MHealth Fairview Minneapolis, Minneapolis, MN;4. Department of Anesthesia/Acute Pain Management, Baptist Health Lexington, Lexington, KY |
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| Abstract: | PurposePostoperative analgesia following minimally invasive video assisted thoracoscopic surgery (VATS) in pediatric patients may involve intravenous opioid analgesics and continuous local anesthetic infusions via an epidural infusion catheter. The use of epidural catheters may avoid systemic side effects of intravenous opioids in this vulnerable population.DesignOur primary aim was to compare total morphine equivalents (MEQ) required, and pain scores between local anesthetic epidural infusion catheters combined with intravenous opioids, versus intravenous opioids alone in pediatric patients following VATS procedure.MethodsFollowing Institutional Review Board approval, we performed a retrospective chart review of children (ages 1 month to 18 years) who underwent VATS procedure for noncardiac thoracic surgery. Based on the postoperative analgesic technique used, the study population was divided into two groups that is, epidural group and nonepidural group. Both groups received intravenous systemic opioids. The primary outcome variables were total MEQ required and pain scores in the perioperative period.FindingsNinety-two patients were included in the study. Of these, 22 patients belonged to the epidural group versus 70 patients to the nonepidural group. There was no statistical difference in MEQ requirements or pain scores between the groups intraoperatively (P = .304), in the postanesthesia care unit (P = .166), or at postoperative time intervals of 24 hours (P = .805) and 48 hours (P = .844). The presence of infection or empyema was a significant factor for the avoidance of epidural placement by providers (P = .003).ConclusionsThere was no significant difference in the perioperative MEQ or postoperative pain scores between the epidural catheter group and the nonepidural group. More research is necessary to determine if this could be due to epidural catheter malposition and/or inadequate dermatomal coverage of surgical chest tubes. |
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