Related Experiment Video
Updated: Aug 24, 2025
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Comparison of subcutaneous analgesic system and epidural analgesia for postoperative pain control in open pediatric
Steven C Mehl1, Brittany Johnson2, Nihar Patel3
1Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States; Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, United States.
Insights
Epidural analgesia provided better early pain control for pediatric cancer surgery patients, but surgeon-placed subcutaneous analgesic systems (SAS) showed fewer complications. Both methods achieved high parental satisfaction, making SAS a viable alternative.
Area of Science:
- Pediatric Surgery
- Oncology
- Pain Management
- Anesthesiology
Background:
- Post-operative pain is a significant concern for children undergoing open oncologic surgery.
- Effective pain management strategies are crucial for recovery and patient well-being.
Purpose of the Study:
- To compare the efficacy and safety of a surgeon-placed subcutaneous analgesic system (SAS) versus epidural analgesia for managing post-operative pain in pediatric patients.
- To evaluate pain scores, analgesic requirements, clinical outcomes, and parental satisfaction.
Main Methods:
- A single-center randomized controlled trial involving 36 children (≤18 years) undergoing open tumor resection.
- Patients were randomized preoperatively to either SAS or epidural analgesia.
- Perioperative pain management was standardized, and families were blinded to the treatment modality.
Main Results:
- The epidural group demonstrated significantly lower oral morphine equivalent (OME) demand on postoperative days one and two.
- Pain scores were comparable between the SAS and epidural groups across the first three postoperative days.
- The epidural group experienced a higher incidence of device complications and urinary catheter use compared to the SAS group.
Conclusions:
- Epidural analgesia appears superior for early post-operative pain control in children undergoing major oncologic surgery.
- Subcutaneous analgesic systems (SAS) offer a favorable safety profile with fewer device complications and reduced urinary catheter use.
- Both SAS and epidural analgesia result in excellent parental satisfaction, positioning SAS as a potential alternative, particularly when epidural placement is not feasible.
Purpose:
Children undergoing open oncologic surgery can have significant post-operative pain. The purpose of this trial was to compare a surgeon-placed subcutaneous analgesic system (SAS) to epidural analgesia.
Methods:
Single center randomized controlled trial including children ≤18 years undergoing open tumor resection between October 2018 and April 2021. Randomization to SAS or epidural was done preoperatively and perioperative pain management was standardized. Families were blinded to the modality. Comparisons of oral morphine equivalents (OME) and pain scores for three postoperative days, clinical outcome parameters, and parental satisfaction following unblinding were completed using non-parametric analyses.
Results:
Of 36 patients (SAS 18, Epidural 18), median age was 5 years (range <1-17). The Epidural cohort had less OME demand on postoperative day one (SAS 0.76 mg/kg, Epidural 0.11 mg/kg; p<0.01) and two (SAS 0.48 mg/kg, Epidural 0.07 mg/kg, p = 0.03). Pain scores were similar on postoperative days 1-3 (0-2 in both groups). The Epidural cohort had more device complications (SAS 11%, Epidural 50%; p = 0.03) and higher urinary catheter use (SAS 50%, Epidural 89%; p = 0.03). More than 80% of parents would use the same device in the future (SAS 100%, Epidural 84%, p = 0.23).
Conclusion:
For children undergoing open oncologic abdominal or thoracic surgery, early post-operative pain control appears to be better with epidural analgesia; however, SAS has decreased incidence of device complications and urinary catheter use. Parental satisfaction is excellent with both modalities. SAS could be considered as an alternative to epidural, especially in settings when epidural placement is not available or contraindicated.
Type Of Study:
Treatment study, Randomized controlled trial.
Level Of Evidence:
Level 1.
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