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Epidural Analgesia Is Associated With Reduced Inpatient Opioid Consumption and Length of Stay After Wilms Tumor
Stephanie Y Chen1, Eric Laifman2, Shale J Mack2
1Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Division of Pediatric Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Insights
Epidural analgesia (EA) reduces postoperative opioid use in children undergoing Wilms' tumor (WT) resection without increasing length of stay (LOS). This suggests EA is beneficial for pain management in pediatric WT patients.
Area of Science:
- Pediatric Oncology
- Pain Management
- Anesthesiology
Background:
- Wilms' tumor (WT) is the most common pediatric renal malignancy.
- Surgical resection of WT typically involves laparotomy.
- Epidural analgesia (EA) is used for postoperative pain but may prolong length of stay (LOS).
Purpose of the Study:
- To investigate the association between EA and postoperative outcomes in children undergoing WT resection.
- To determine if EA impacts LOS and opioid consumption.
Main Methods:
- Retrospective chart review of WT patients undergoing nephrectomy (1998-2018).
- Exclusion criteria included incomplete records, bilateral WT, tumor extension, and postoperative intubation.
- Outcomes: postoperative opioid consumption, discharge opioid prescriptions, and LOS.
Main Results:
- Children receiving EA used significantly less inpatient opioids (1.0 vs. 3.3 MME/kg; P < 0.001).
- No significant difference in opioid discharge prescriptions (57% vs. 39%; P = 0.13).
- Multivariable analysis showed EA associated with shorter LOS (coefficient -0.73; P = 0.04).
Conclusions:
- Epidural analgesia is linked to reduced opioid use in pediatric WT patients.
- EA does not appear to increase postoperative length of stay.
- EA should be considered in multimodal pain management strategies for pediatric WT resection.
Introduction:
Wilms' tumor (WT) is the most common renal malignancy in children and requires an extensive laparotomy for resection. Epidural analgesia (EA) is commonly used in postoperative pain management, but previous literature suggests it may prolong length of stay (LOS). We hypothesized that EA is associated with prolonged LOS but decreased postoperative opioid use in children undergoing WT resection.
Materials And Methods:
A retrospective chart review was performed for all WT patients who underwent nephrectomy between January 1, 1998, and December 31, 2018, at a tertiary children's hospital. Patients with incomplete records, bilateral WT, caval or cardiac tumor extension, or intubation postoperatively were excluded. Outcomes included postoperative opioid consumption measured in oral morphine equivalents per kilogram, receipt of opioid prescription at discharge, and postoperative LOS. Mann-Whitney and multivariable regression analyses were performed.
Results:
Overall, 46/77 children undergoing WT resection received EA. Children with EA used significantly less inpatient opioids than children without EA (median 1.0 vs. 3.3 oral morphine equivalents per kilogram; P < 0.001). Comparing patients with EA to patients without, there was no significant difference in opioid discharge prescriptions (57% vs. 39%; P = 0.13) or postoperative LOS (median 5 d vs. 6 d; P = 0.10). Controlling for age and disease stage, EA was associated with shorter LOS by multivariable regression (coefficient -0.73, 95% confidence interval: -1.4, -0.05; P = 0.04).
Conclusions:
EA is associated with decreased opioid use in children without an associated increase in postoperative LOS following WT resection. EA should be considered as part of multimodal pain management for children undergoing WT resection.
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