Retrospective Study Comparing the Efficacy of Epidural Analgesia to Perineural Nerve Catheter Analgesia for Postoperative Pain Management in Pediatric Patients Following a Unilateral Lower Limb Surgery
AffiliationThe University of Arizona College of Medicine – Phoenix
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PublisherThe University of Arizona.
DescriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
AbstractThe primary aim of this study was to determine if peripheral nerve catheterization offers a better analgesic alternative than an epidural catheter in pediatric patients who undergo a unilateral lower limb surgery. Postoperative pain management is not only important in promoting comfort to patients in pain but can also promote rehabilitation and optimal healing. Multimodal analgesia is the use of multiple modalities to treat patients’ pain; two of these methods include epidural and peripheral catheters. Epidural catheter infusions offer global analgesia from the waist to both of the lower extremities. Epidurals do pose side effect risks that include infection, urinary retention, hypotension, pruritus, nausea/vomiting, headaches, backaches, and respiratory depression. Peripheral nerve infusions can act more locally at a targeted area and deliver carefully dosed anesthetics to nerve fibers that can hinder the sensory function of nerves while preserving the motor function, allowing for earlier rehabilitation. The use of multimodal analgesia as a postoperative pain management plan can still vary greatly from clinician to clinician, so it would be of benefit to determine which subset of patients may benefit from having a catheter infusion as part of their treatment regimen and whether a peripheral infusion is superior to an epidural infusion. This was a retrospective study that looked at 65 pediatric patients, ages 5-15, that received either an epidural infusion (n = 53) or a peripheral nerve block infusion (n = 12) for a unilateral lower limb operation. Their charts were analyzed to determine pain scores, PCA usage, PRN morphine equivalents, total morphine equivalents, adverse events, length of catheter use, and length of hospital stay, amongst other things. The epidural group was used as the control for the study and the data analysis revealed that the patients that received a peripheral infusion had 43% higher (p = 0.35) pain scores, received 98% less (p = 0.001) continuous morphine equivalents in their infusions, required 31% less (p = 0.34) PRN morphine equivalents, had 68% less (p = 0.049) PCA usage rates, received 32% less (p = 0.39) total morphine equivalents, had 30% less (p = 0.45) adverse effects, and left the hospital 0.54 days earlier (p = 0.13) on average when compared to patients that received continuous epidural infusions. The data indicates that although the pains scores were higher for the peripheral infusion patients, these patients required less opioid exposure, which indicates relatively acceptable pain management for the patient and healthcare team while also allowing for the opportunity to engage in rehabilitation and avoid the global effects of epidural infusions and the associated increased profile risk. The conclusion of this study suggests that continuous peripheral infusions are a valid alternative to epidural infusions for pediatric patients that undergo a unilateral lower limb surgery and that a randomized control trial would be warranted to offer more definitive insight.