Epidural Analgesia Reduces Total Inhospital Morphine Requirements Post Heart Lung / Lung Transplant in Paediatric Population

Abstract

Purpose Patients undergoing heart lung / lung transplantation utilise extensive hospital resources. Pain management is an important factor in post surgery recovery, influencing respiratory and other health outcomes and hospital resource burden. To our knowledge, no previous study has evaluated analgesic practices in the paediatric heart lung / lung transplant population. Methods We conducted a retrospective analysis of all paediatric patients (age less than 18 years) who underwent heart / lung transplant at a single tertiary centre between January 2006 and January 2018. Results 39 subjects were identified, of whom 30 had epidural analgesia (plus / minus adjunctive systemic analgesia). All epidurals were ceased by day 5. Mean age of epidural analgesia patients was 12.6 years; mean age of systemic analgesia patients was 11.6. Epidural analgesia, when compared with systemic analgesia, was associated with a significantly reduced total in-hospital morphine requirement (mean 1.65 vs 2.74mg/kg/24 hours) (p = 0.02). There were no epidural-related or opioid-related episodes of harm CTCAE grade 4 or greater (nil life threatening events). There was no meaningful correlation between total in-hospital morphine requirements and CTCAE grades of harm (correlation coefficient = 0.15). In addition, both epidural and systemic analgesia had similar endotracheal tube days (p = 0.56) and ICU days (p = 0.90). In all patients, opioid requirements during day 5 postoperative correlated with total hospital morphine requirements (correlation coefficient = 0.46). Conclusion Epidural analgesia reduces total in-hospital morphine requirements post heart lung / lung transplant in paediatric population. Epidural analgesia and systemic analgesia both appear safe in this setting.