Abstract
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.
Highlights
Regional anaesthesia combined with general anaesthesia reduces stress response to surgery, duration of ventilation, intensive care unit (ICU) stay and promotes early recovery
All the three groups were comparable in terms of age, sex, weight, cardiopulmonary bypass time, surgical time and mean RACHS score (Table 1)
Post-operative pain scores were lower in caudal analgesia group during post-operative period in our study similar to previous studies done by Abd-Elshafy et al [16], Samantaray et al [11], Nasr and Abdel Hamid et al [17]
Summary
Regional anaesthesia combined with general anaesthesia reduces stress response to surgery, duration of ventilation, intensive care unit (ICU) stay and promotes early recovery. Regional anaesthesia provides many advantages to patients by providing analgesia, attenuation of stress response, reduction in morbidity and mortality [1] Despite of these advantages practice of regional anaesthesia in paediatric cardiac surgery was limited due to major believes like epidural hematoma and hemodynamic disturbances. Inadequate pain relief during intra operative and post-operative period contribute to metabolic (proteolysis, hyperglycaemia), neuroendocrine (increase in serum cortisol and catecholamine levels), immunological (inhibition of NK cell and T helper cell function) and haematological changes (post-operative hyper coagulable state) [6] These changes can be minimized by administering a combination of regional anaesthesia and general anaesthesia, thereby provide adequate pain relief and decreases the duration of ventilation and stay in intensive care unit [5] [7] [8] [9]
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