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Updated: Sep 21, 2025

Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
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Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia

Published on: May 26, 2023

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Addition of Local Anesthetic Epidural Infusion Catheter to Intravenous Opioid Analgesia for Postoperative Pain

Shannon M Grap1, Erik B Lehman2, Victoria Heasley1

  • 1Department of Anesthesiology & Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center & Children's Hospital, Hershey, PA.

Journal of Perianesthesia Nursing : Official Journal of the American Society of Perianesthesia Nurses
|May 27, 2022
PubMed

Insights

For pediatric patients undergoing VATS surgery, epidural catheters combined with IV opioids did not significantly reduce morphine equivalents or pain scores compared to IV opioids alone. Further research is needed to explore potential reasons for this finding.

Area of Science:

  • Pediatric Anesthesiology
  • Thoracic Surgery
  • Pain Management

Background:

  • Minimally invasive video-assisted thoracoscopic surgery (VATS) in children often requires effective postoperative pain management.
  • Epidural analgesia is a potential strategy to reduce opioid use and systemic side effects in pediatric patients.

Purpose of the Study:

  • To compare the efficacy of epidural analgesia combined with intravenous opioids versus intravenous opioids alone in pediatric patients following VATS.
  • To evaluate differences in total morphine equivalents (MEQ) and pain scores between the two analgesic approaches.

Main Methods:

  • Retrospective chart review of pediatric patients (1 month to 18 years) undergoing noncardiac thoracic VATS.
  • Patients were divided into two groups: those receiving epidural infusion catheters and those not (nonepidural group).
  • Both groups received intravenous systemic opioids; primary outcomes were perioperative MEQ and pain scores.

Main Results:

  • Ninety-two patients were analyzed (22 in epidural group, 70 in nonepidural group).
  • No statistically significant differences in MEQ requirements or pain scores were observed between groups intraoperatively, in the PACU, or at 24 and 48 hours postoperatively.
  • Presence of infection or empyema was a significant factor influencing the decision to avoid epidural placement (P=.003).

Conclusions:

  • Epidural catheter use did not significantly alter perioperative opioid consumption or postoperative pain scores in pediatric VATS patients compared to intravenous opioids alone.
  • Further investigation is warranted to determine if factors like epidural catheter malposition or inadequate coverage contributed to the lack of observed benefit.
Abstract

Keywords:
analgesiapediatric, video-assisted thoracoscopic surgery (VATS), epidural

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