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Updated: Aug 5, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
Epidural analgesia improves outcome following pediatric fundoplication. A retrospective analysis
J K McNeely1, N E Farber, L M Rusy
1Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, USA.
Insights
Epidural analgesia significantly reduced postoperative complications and hospital costs in pediatric fundoplication patients compared to intravenous opioids. This approach improved recovery and decreased the need for prolonged mechanical ventilation.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Pain Management
Background:
- Nissen fundoplication is a frequent surgical procedure for high-risk pediatric patients.
- Optimizing postoperative care is crucial for this vulnerable population.
Purpose of the Study:
- To compare the effects of epidural versus intravenous opioid analgesia on the postoperative outcomes of pediatric fundoplication.
- To evaluate the influence on morbidity, functional recovery, and economic impact.
Main Methods:
- Retrospective cohort study of 155 pediatric patients (1 month-19 years) undergoing fundoplication.
- Comparison of patients receiving epidural opioids (n=72) versus parenteral opioids (n=83).
- Analysis of postoperative complications, recovery of bowel/bladder function, and hospital charges.
Main Results:
- The epidural group showed a significantly lower complication rate (5.5% vs. 20%, P < .001).
- Fewer patients in the epidural group required prolonged mechanical ventilation (4 vs. 15).
- Epidural analgesia led to earlier hospital discharge and approximately 20% lower hospital charges.
Conclusions:
- Perioperative epidural analgesia may enhance outcomes in high-risk pediatric patients undergoing fundoplication.
- Administration by a dedicated pain service is suggested for optimal results.
Background And Objectives:
Nissen fundoplication is a common procedure in high-risk pediatric patients. This cohort study evaluated the influence of epidural versus intravenous opioid analgesia on the postoperative course of infants and children undergoing fundoplication.
Methods:
A retrospective review was made of the perioperative courses of 155 consecutive patients, aged 1 month to 19 years, who underwent elective open fundoplication from January 1993 to October 1994. Of these 155 patients, 72 received perioperative analgesia with epidural opioids, while 83 received parenteral opioids. Outcome variables included major morbidity factors, recovery of bowel and bladder function, and economic impact.
Results:
Patients in the epidural and parenteral groups did not differ with respect to age, weight, or associated preoperative medical diagnoses. The postoperative complication rate was significantly decreased in the epidural group (5.5% versus 20%) (P < .001). In the epidural group 4 patients required mechanical ventilation for longer than 24 hours, compared with 15 in the parenteral group. Patients in the epidural group were discharged earlier from the hospital and incurred approximately 20% less in hospital charges on average than their cohorts in the intravenous group.
Conclusions:
These findings suggest that perioperative epidural analgesia, administered by a dedicated pain service, amy improve outcome in high-risk pediatric patients undergoing fundoplication.
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