P31
ANALGESIC MANAGEMENT AND THE EARLY RECOVERY PROFILE OF PAEDIATRIC CARDIAC SURGICAL PATIENTS IN A TERTIARY CHILDREN’S HOSPITAL
B. O. Atandi, P. Arnold
Alder Hey Children’s NHS Foundation Trust, UK
Introduction and Aims
Analgesic management of paediatric cardiac surgical patients is often challenging yet a prerequisite to their recovery. Ultrasound guided thoracic paravertebral blocks can be used as part of multimodal analgesia, and might reduce opioid consumption in surgical patients.[1] Our aim was to describe the intraoperative analgesic management and early recovery characteristics of paediatric cardiac surgery patients within our hospital, comparing those who had single shot ultrasound guided paravertebral blocks to those who did not.
Methods
A retrospective analysis of data from electronic patient records on intraoperative analgesic techniques and recovery outcomes of all cardiac surgical patients in a tertiary paediatric hospital over a 2-year period. We compared patients who received single-shot ultrasound guided paravertebral blocks and those who did not. The primary outcomes were successful extubation at the end of surgery, or within 24hours, and length of hospital stay.
Results
519 cardiac surgeries were performed between 1/12/2021 and 12/12/2023. The median patient age was 0.6 years (IQR, 0.19-2.86), and weight 6.6kg (IQR, 4.0-12.7). All patients had variable combinations of multimodal analgesia with paracetamol, opioids, adjuvants such as single-shot paravertebral blocks, and dexmedetomidine. Extubation at the end of surgery was more frequent in 86/144(59.7%) patients who had blocks, versus 38/375(10.1%) who did not. Among those not extubated in theatres, a slightly larger proportion of those who had blocks were extubated within 24 hours of arrival to the paediatric ICU (16.7% versus 12%). Overall, 110 patients (76.4%) who received blocks were extubated within 24hours, compared to 83 (22.4%) who did not receive blocks, (OR, 11.2; 7.1-17.7). The mean (±SD) intraoperative fentanyl dose was lower with blocks; 3.8±3.8 mcg/kg versus 23.7±13.9 mcg/kg. Length of stay was lower among those who had blocks; 7(IQR, 5-10) versus 12(IQR, 7-20) days.
Conclusions
Higher rates of extubation at the end of surgery and within 24hours, lower intraoperative opioid analgesic doses, and shorter duration of hospitalization were recorded in patients who had paravertebral blocks as part of multimodal analgesia. We would expect selection bias in choosing patients who had blocks in place, and it would be incorrect at this stage to state that blocks lead to higher extubation rates. Our intention is to conduct further analysis to reduce this bias, however prospective trials of effectiveness will be required to establish the role of regional analgesia. Our study is further limited by the heterogeneity of patients, and the acquisition of data from a recently introduced electronic record keeping system whose initial use could have been inaccurate or incomplete.
Reference:
- Naganuma M, Tokita T, Sato Y, Kasai T, Kudo Y, Suzuki N, et al. Efficacy of Preoperative Bilateral Thoracic Paravertebral Block in Cardiac Surgery Requiring Full Heparinization: A Propensity-Matched Study. J Cardiothorac Vasc Anesth. 2022;36(2):477-482. doi: 10.1053/j.jvca.2021.05.001.