Thoracic epidural analgesia safely and with great success in adolescents

TOP LINE:

Thoracic epidural analgesia (TEA) has a high success rate in adolescents undergoing chest wall surgery, with no long-term adverse effects or manageable complications.

METHODOLOGY:

• Researchers conducted a retrospective observational cohort study including 532 adolescent patients (mean age 15 years) who underwent chest wall surgery at a high-volume academic medical center in Belgium.
• All operations concerned the correction of the concave or pigeon chest.
• Board-certified anesthesiologists or senior anesthesiology residents placed epidural catheters at the T5-T6, T6-T7, or T7-T8 levels. Patients received a bolus dose of 0.25% levobupivacaine at 0.1 mL/kg at the beginning and end of surgery, followed by continuous low-dose epidural analgesia with levobupivacaine and sufentanil after the procedure.
• The primary outcome was the incidence of acute adverse events within 5 days.
• Secondary outcomes were rates of successful nerve block, defined as adequate analgesia after emergence from general anesthesia (or after supplementation) and absence of need for rescue analgesics.

TAKE AWAY:

• TEA provided adequate postoperative pain relief in 81% of cases.
• Approximately 60% of patients experienced one or more minor acute adverse events, but no long-term complications occurred.
• Late postoperative nausea and vomiting (33%) and itching (26%) were the most common adverse events, while early events included a sudden drop in heart rate and blood pressure (5%), insertion difficile (4%) and paresthesias. (2%) and bloody bites (2%).
• Short-term events included Horner syndrome (2%), which resolves after TEA removal, and unilateral block (2%).

IN PRACTICE:

“Although TEA is no longer considered the gold standard for chest wall deformities, it provides excellent pain control.” the researchers reported. “A re-evaluation of TEA as a valid, safe and exceptionally effective locoregional technique for chest wall surgery may be necessary. Length of hospital stay is a cause for concern and can be reduced by combining TEA with other modalities,” they added. .

SOURCE:

This study was led by Steve Coppens, MD, of the Department of Anesthesiology at Leuven University Hospitals, Leuven, Belgium. It was published online on October 4, 2024 in the European Journal of Anesthesiology.

BOUNDARIES:

The retrospective design of the study may have introduced information and selection bias. The cohort included insufficient numbers of patients to identify rarer but potentially serious complications such as epidural hematomas. Study results may not be reproducible in centers with lower numbers of thoracic epidural cases.

DISCLOSURES:

The study did not benefit from any specific funding. One author reported receiving funding for webinars, workshops, and conferences from medical technology and health solutions companies, as well as research grants for previous research projects.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.