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Epidural analgesia improves outcome following pediatric fundoplication. A retrospective analysis. Reg Anesth 1997;22(1):16-23

Date

01/01/1997

Pubmed ID

9010942

DOI

10.1016/s1098-7339(06)80051-9

Scopus ID

2-s2.0-0031037734 (requires institutional sign-in at Scopus site)   88 Citations

Abstract

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.

Author List

McNeely JK, Farber NE, Rusy LM, Hoffman GM

Authors

George M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin
Lynn M. Rusy MD Professor in the Anesthesiology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Age Factors
Analgesia, Epidural
Analgesics, Opioid
Child
Child, Preschool
Cohort Studies
Female
Fundoplication
Humans
Infant
Infant, Newborn
Injections, Epidural
Injections, Intravenous
Length of Stay
Male
Postoperative Complications
Retrospective Studies
Treatment Outcome