TITLE:
A Comparative Study on Safety and Efficacy of Caudal, Thoracic Epidural and Intra Venous Analgesia in Paediatric Cardiac Surgery: A Double Blind Randomised Trial
AUTHORS:
Mahesh Vakamudi, Rajesh Kumar V. Kodali, Ranjith B. Karthekeyan, Periyasamy Thangavel, Kamalakannan G. Sambandham
KEYWORDS:
Caudal Analgesia, Thoracic Epidural Analgesia, Pain Scores, Paediatric Cardiac Surgery
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.10 No.7,
July
7,
2020
ABSTRACT: Introduction:Regional anaesthesia combined
with general anaesthesia reduces stress response to
surgery, duration of ventilation, intensive care unit (ICU) stay and promotes early recovery. Studies on
thoracic epidural, caudal analgesia along with general anaesthesia (GA) in paediatric cardiac surgery are
limited hence we aimed to compare efficacy
and safety of caudal, thoracic epidural and intravenous analgesia in
paediatric cardiac surgery. Methodology: This study was conducted in the
Department of Anaesthesiology in a tertiary care teaching hospital in southern
India from February 2019 to December 2019. 90 children were randomised into
group A, group B, group C. Children in group A received caudal analgesia along
with GA. Group B children received thoracic epidural along with GA. Group C
patients received intravenous analgesia along with GA. Rescue analgesia 1 mcg/kg
fentanyl given in all 3 groups if pain
score is more than 4. Primary outcome assessed was post-op pain scores. Secondary outcome assessed
was duration of ventilation, duration of intensive care unit stay. Results: All patients were comparable in terms of age, sex, weight, mean RACHS score, baseline heart rate and blood pressure. Pain
scores were significantly lower in
thoracic epidural group compared to other two grou ps. Duration of
ventilation was lower in thoracic epidural group (91.17± 43.85) minutes and caudal (199.6 ± 723.59) minutes compared to intravenous analgesia
groups (436.37 ± 705.51)
minutes. Duration of ICU stay was significantly low in thoracic epidural group
(2.73 ± 0.69) days compared to
caudal (3.7 ± 2.8) and
intravenous analgesia groups (4.33 ± 0.920). We didn’t have any
complications like hematoma, transient or permanent neurological sequelae in
regional anesthesia groups. Conclusion: Regional anaesthesia along with general
anaesthesia was more effective in pain relief than intravenous analgesia with
general anaesthesia in paediatric cardiac surgery.