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Updated: Jul 11, 2025
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Perioperative Regional Anesthesia Pain Outcomes in Children: A Retrospective Study of 3160 Regional Anesthetics in
James Xie1, Elizabeth De Souza, Felipe Perez
1Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA.
Insights
Regional anesthesia (RA) in children showed mixed results for pain and opioid use in routine practice. While some techniques reduced intraoperative and PACU opioid needs, overall benefits were not consistently observed.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Regional Anesthesia Techniques
Background:
- Randomized controlled trials suggest regional anesthesia (RA) improves postoperative outcomes, including reduced pain and opioid consumption.
- Routine clinical practice may differ from trial settings, necessitating evaluation of RA's real-world effectiveness in pediatric patients.
Purpose of the Study:
- To assess the association of regional anesthesia (RA), regardless of technique, with perioperative pain and opioid use in a pediatric hospital setting.
- To compare outcomes between single-shot blocks, catheter-based blocks, and no-block groups in children undergoing surgery.
Main Methods:
- Retrospective cohort study of 11,292 pediatric patients (≤18 years) from May 2014 to September 2021.
- Categorization into single-shot, catheter-based, or no regional anesthesia (RA) groups.
- Analysis of intraoperative and PACU opioid exposure, pain scores, length of stay, and cumulative opioid consumption using regression models.
Main Results:
- Compared to no block, both single-shot and catheter-based RA were associated with opioid-free intraoperative anesthesia and PACU stays.
- Catheter-based RA reduced PACU and inpatient opioid use up to 24 hours postoperatively, but showed no difference at 24-36 hours and increased use from 36-72 hours.
- Single-shot RA did not improve inpatient pain scores or reduce opioid use post-PACU. Overall, RA was not linked to reduced cumulative opioid consumption.
Conclusions:
- The association of regional anesthesia (RA) with pediatric pain and opioid use outcomes in routine practice is mixed.
- Further research is needed to optimize the application and maximize the benefits of RA in pediatric surgical patients.
Objective:
Randomized controlled trials indicate regional anesthesia (RA) improves postoperative outcomes with reduced pain and opioid consumption. Therefore, we hypothesized children who received RA, regardless of technique, would have reduced pain/opioid use in routine practice.
Methods:
Using a retrospective cohort, we assessed the association of RA with perioperative outcomes in everyday practice at our academic pediatric hospital. Patients 18 years or below undergoing orthopedic, urologic, or general surgeries with and without RA from May 2014 to September 2021 were categorized as single shot, catheter based, or no block. Outcomes included intraoperative opioid exposure and dose, preincision anesthesia time, postanesthesia care unit (PACU) opioid exposure and dose, PACU antiemetic/antipruritic administration, PACU/inpatient pain scores, PACU/inpatient lengths of stay, and cumulative opioid exposure. Regression models estimated the adjusted association of RA with outcomes, controlling for multiple variables.
Results:
A total of 11,292 procedures with 3160 RAs were included. Compared with no-block group, single-shot and catheter-based blocks were associated with opioid-free intraoperative anesthesia and opioid-free PACU stays. Post-PACU (ie, while inpatient), single-shot blocks were not associated with improved pain scores or reduced opioid use. Catheter-based blocks were associated with reduced PACU and inpatient opioid use until 24 hours postop, no difference in opioid use from 24 to 36 hours, and a higher probability of use from 36 to 72 hours. RA was not associated with reduced cumulative opioid consumption.
Discussion:
Despite adjustment for confounders, the association of RA with pediatric pain/opioid use outcomes was mixed. Further investigation is necessary to maximize the benefits of RA.
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