K. W. Gonzalez1, B. G. Dalton1, P. Thomas1, S. W. Sharp1, S. D. St. Peter1 1Children’s Mercy Hospital- University Of Missouri Kansas City,Pediatric Surgery,Kansas City, MO, USA
Introduction:
Optimizing postoperative pain control in patients undergoing thoracotomy can be challenging and utilize substantial resources. The use of thoracic epidural is standard in adult patients who undergo thoracotomy to facilitate earlier mobilization, deep breathing and minimize narcotic effects. However, a recent randomized trial in pediatric patients who undergo repair of pectus excavatum suggests patient controlled analgesia (PCA) produces a similar post-operative course as epidural but is less costly, less time consuming and non-invasive. Given thoracotomy is typically less painful than pectus bar placement, we compared the outcomes of epidural to PCA for pain management after pediatric thoracotomy.
Methods:
A retrospective review was conducted in patients who underwent thoracotomy at a children’s hospital between 2004 and 2013. Data points included operative details, epidural or PCA use, urinary catheterization, days to regular diet, days to oral pain regimen, pain scores in the postoperative care unit and during admission, length of stay, and anesthesia charges. Patients were excluded if they did not have epidural or PCA following thoracotomy. Comparative analysis was performed utilizing 2-tailed Student t-tests.
Results:
There were 17 patients who underwent thoracotomy, of which 6 were treated with an epidural and 11 with a PCA. Of the patients who received an epidural, 3 were opiate naïve, compared to 2 with a PCA. The most common indication for thoracotomy was metastatic osteosarcoma (n=13). When comparing epidural versus PCA, there was no significant difference in time to removal of foley catheter, days to regular diet, days to oral pain control, length of stay, or total operating room time. Pain scores obtained in the postoperative care unit and during admission were also comparable. The mean anesthesia charges were significantly higher in patients with an epidural versus PCA (Table 1).
Conclusion:
Epidural catheter and PCA provide comparable pain relief and objective recovery course in children who undergo thoracotomy, however, epidural catheter placement is associated with increased anesthesia charges suggesting PCA is a noninvasive, cost effective alternative.
