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Comparison between epidural and opioid analgesia for infants undergoing major abdominal surgery

Lizabeth D Martin1, Trevor L Adams1, Laura C Duling1

  • 1Department of Anesthesiology and Pain Management, University Washington Medical School, Seattle Children's Hospital, Seattle, Washington.

Paediatric Anaesthesia
|May 30, 2019
PubMed

Insights

Epidural analgesia in infants undergoing major abdominal surgery reduced intraoperative opioid use. However, it did not significantly impact postoperative pain scores or anesthetic exposure, necessitating further research.

Area of Science:

  • Pediatric Surgery
  • Anesthesiology
  • Pain Management

Background:

  • Epidural analgesia is optimal for postoperative pain management after major abdominal surgery.
  • Infants are vulnerable to respiratory depression and anesthetic neurotoxicity, making reduced anesthetic and opioid exposure desirable.

Purpose of the Study:

  • To determine if epidural catheter use decreased anesthetic and opioid exposure in infants undergoing major abdominal surgery.
  • To assess the impact of epidural analgesia on postoperative pain management in this population.

Main Methods:

  • Retrospective cohort study of infants (<12 months) undergoing major abdominal surgery.
  • Comparison of anesthetic exposure (sevoflurane) and intraoperative opioid administration between infants with and without epidural catheters.
  • Analysis of postoperative pain and sedation scores, and morphine equivalents.

Main Results:

  • Infants with epidurals received less intraoperative fentanyl and morphine (univariate analysis).
  • Epidural use was associated with significantly less long-acting opioid administration after controlling for covariates.
  • Mean endtidal sevoflurane concentrations and postoperative morphine equivalents were similar between groups.

Conclusions:

  • Epidural catheter placement in infants undergoing major abdominal surgery is linked to reduced intraoperative long-acting opioid requirements.
  • Epidural analgesia does not eliminate opioid exposure, as opioids may be used for other indications in infants.
  • Prospective studies are needed to precisely quantify the effect of epidural analgesia on intraoperative anesthetic exposure in infants.
Abstract

Keywords:
infantopioidspainregional

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