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Abstract
Introduction Regional techniques are a key component of multimodal analgesia and help decrease opioid use perioperatively, but some techniques may not be suitable for all patients, such as those with spina bifida. We hypothesized peripheral regional catheters would reduce postoperative opioid use compared with no regional analgesia without increasing pain scores in pediatric patients with spina bifida undergoing major urological surgery.
Methods A retrospective review of a multicenter database established for the study of enhanced recovery after surgery was performed of patients from 2009 to 2021 who underwent bladder augmentation or creation of catheterizable channels. Patients without spina bifida and those receiving epidural analgesia were excluded. Opioids were converted into morphine equivalents and normalized to patient weight.
Results 158 patients with pediatric spina bifida from 7 centers were included, including 87 with and 71 without regional catheters. There were no differences in baseline patient factors. Anesthesia setup increased from median 40 min (IQR 34–51) for no regional to 64 min (IQR 40–97) for regional catheters (p<0.01). The regional catheter group had lower median intraoperative opioid usage (0.24 vs 0.80 mg/kg morphine equivalents, p<0.01) as well as lower in-hospital postoperative opioid usage (0.05 vs 0.23 mg/kg/day morphine equivalents, p<0.01). Pain scores were not higher in the regional catheters group.
Discussion Continuous regional analgesia following major urological surgery in children with spina bifida was associated with a 70% intraoperative and 78% postoperative reduction in opioids without higher pain scores. This approach should be considered for similar surgical interventions in this population.
Trial registration number NCT03245242.
- nerve block
- pain, postoperative
- pain management
- regional anesthesia
- pediatrics
Data availability statement
Data are available upon reasonable request.
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Data availability statement
Data are available upon reasonable request.
Footnotes
Twitter @rm2382, @vidyachidambar1, @kylerove
Collaborators PURSUE Study Group: these are PURSUE collaborators (in addition to the main study author names listed): Yvonne Y. Chan, Dominic Frimberger, C. D. Anthony Herndon, Adam J. Rensing, Bhalaajee Meenakshi-Sundaram, Paul A. Merguerian, Erica J. Traxel, Brian VanderBrink, Vijaya M. Vemulakonda, Douglas E. Coplen, Timothy P. Welch, Duncan T. Wilcox, Elizabeth B. Yerkes, Carter J. Sevick.
Contributors RPM designed the study, aided with patient selection from the PURSUE database, analyzed the data, drafted and revised the paper. NEB designed the study, is a site investigator for Ann & Robert H Lurie Children’s Hospital, aided creation of local ERAS protocol for anesthesiology, monitored local data collection, drafted and revised the paper. MAB designed the study, is a site investigator for Children’s Hospital Colorado, created ERAS protocol for anesthesiology, advised other sites on creation of their local protocols, is a key organizing member of PURSUE, aided creation of data collection tools, monitored local data collection, drafted and revised the paper. ACS is the site primary investigator for Cincinnati Children’s, is a key organizing member of PURSUE, aided creation of data collection tools, monitored local data collection, drafted and revised the paper. AA participated in study design, aided data collection, aided the analysis, drafted and revised the paper. PJB participated in study design, aided data collection, aided the analysis, drafted and revised the paper. VC is a site investigator for Cincinnati Children's Hospital Medical Center, aided creation of local ERAS protocol for anesthesiology, monitored local data collection, drafted and revised the paper. GJV is the site primary investigator for St. Louis Children’s Hospital, aided with ERAS protocol development locally for pediatric urology, drafted and revised the paper. DIC is the site primary investigator for Ann & Robert H Lurie Children’s Hospital, implemented ERAS for pediatric urology, monitored local data collection, aided the analysis, drafted and revised the paper. MS-R is a site investigator for Children's Hospital of Richmond at VCU, aided creation of local ERAS protocol for anesthesiology, monitored local data collection, drafted and revised the paper. RSZ is the site primary investigator for Children’s Hospital of Richmond at VCU, implemented ERAS for pediatric urology, monitored local data collection, drafted and revised the paper. FPC is a site investigator for Children’s Hospital of Pittsburgh, aided creation of local ERAS protocol for anesthesiology, monitored local data collection, drafted and revised the paper. RC is the site primary investigator for Children’s Hospital of Pittsburgh, implemented ERAS for pediatric urology, monitored local data collection, drafted and revised the paper. VNO is a site investigator for Seattle Children’s Hospital, aided creation of local ERAS protocol for anesthesiology, monitored local data collection, drafted and revised the paper. JJA is the site primary investigator for Seattle Children’s Hospital, implemented ERAS for pediatric urology, aided with and monitored local data collection, drafted and revised the paper. KOR initiated and organized the multicenter PURSUE study that under pins the data behind this study and designed this study, is the study primary investigator, created the data collection tools, monitored data collection for the whole study, analyzed the data, drafted and revised the paper. He is the senior author and guarantor. All members of PURSUE designed the trial that under pins the data for this retrospective observational study. Paul F. Austin contributed patients to the PURSUE database and aided with development of the PURSUE protocol. Yvonne Y. Chan aided with data collection and monitoring, Dominic Frimberger contributed patients to the PURSUE database and participates as a study group member. CD Anthony Herndon, Adam J Rensing contributed patients to the PURSUE database and participates as a study group member, Bhalaajee Meenakshi-Sundaram contributed patients to the PURSUE database and participates as a study group member, Paul A Merguerian contributed patients to the PURSUE database and participates as a study group member, Erica J Traxel contributed patients to the PURSUE database and participates as a study group member, Brian VanderBrink contributed patients to the PURSUE database and participates as a study group member, Vijaya M Vemulakonda contributed patients to the PURSUE database and participates as a study group member, Douglas E Coplen is a site investigator, aided with ERAS protocol development and implementation and participates as a study group member. Timothy P Welch aided PURSUE protocol development and local anesthesiology ERAS protocol implementation. Duncan T Wilcox contributed patients to the PURSUE database, Elizabeth B Yerkes contributed patients to the PURSUE database and participates as a study group member. Carter J Sevick assisted with the statistical analysis. KR is the guarantor.
Competing interests KOR is a site investigator for AbbVie.
Provenance and peer review Not commissioned; externally peer reviewed.
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