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Background and Aims Regional anesthesia is not as widely used for pediatric cases as for adults, and whether it significantly decreases intra- and postoperative opioid use or has an impact on short-term outcomes such as time in PACU, discharge and readmission is still unclear.

Methods We retrospectively reviewed all pediatric patients (age ≤17) who underwent surgery with general anesthesia at our center between 2016 and 2021. Patients were broken down into a group that did not receive regional anesthesia and a group that did. Data collected included intra-operative opioids in morphine milligram equivalent per kg, PACU LOS, postoperative respiratory complications, postoperative hospital LOS, and 30-day readmission.

Results Out of 21,863 patients, after excluding ASA > 4, patients who were intubated or had a tracheotomy preoperatively, and records with missing data, 20,878 records were included. Analysis included adjusting for confounders. Opioid use (in morphine equivalent per kg) was significantly lower in the regional group (N=1,248) than in the no-regional group (N=19,630): 0.40 ± 1.01 vs. 0.58 ± 1.83; p < 0.001. There was no significant difference in PACU LOS, postoperative respiratory complications, 30-day readmission or postoperative hospital LOS. However, postoperative HLOS was significantly shorter in the regional group when excluding ambulatory patients: 4.8 ± 11.1 vs. 6.9 ± 18.6 days; p = 0.049; adjusted absolute difference 0.19 days or about 4.5 hours.

Conclusions In our sample of pediatric patients, regional anesthesia significantly decreased opioid use. For inpatients, HLOS was also significantly reduced.