Regional Anesthesia Versus Systemic Analgesia in Thoracotomies for Congenital Cardiac Surgery: A Retrospective Case Series in a Quaternary Care Children's Hospital

Background/objectives Limited studies have characterized differences in postoperative outcomes between regional anesthetic techniques with systemic analgesia and systemic analgesia alone in thoracotomies for congenital cardiac surgery. This retrospective case series aimed to assess the efficacy of regional anesthetic techniques in improving postoperative outcomes in children undergoing thoracotomies for cardiac surgery in comparison to children who only received systemic analgesia without any regional anesthesia. Methods Perioperative data from patients under 18 years of age who underwent thoracotomy for coarctation of the aorta or vascular ring repair between January 2017 and March 2022 in a single-center quaternary care children's hospital were collected, including the presence or absence of a regional or neuraxial anesthetic technique. Primary outcomes collected were 24-hour postoperative pain scores and 24-hour opioid consumption. Secondary outcomes collected were incidence of moderate pain, time to extubation, and block complications. Results One hundred and forty patients underwent thoracotomy for coarctation or vascular ring in the study period. Regional or neuraxial anesthesia (paravertebral, erector spinae plane, serratus anterior, or caudal opioid) was utilized in 62 (44.3%) cases. Paravertebral blocks were the most common block. Both groups demonstrated well-controlled pain throughout the first 24 hours. Twenty-four-hour opioid consumption (mg/kg of intravenous morphine equivalents (IME)) was similar between regional and non-regional groups (0.36 (0.20, 0.54) versus 0.39 (0.18, 0.62); p=0.48). There was no statistically significant difference in the incidence of moderate pain between groups. Conclusions Pain was well-controlled in patients who received regional plus systemic analgesia as well as patients who received systemic analgesia alone, with no differences in pain scores, moderate pain, or opioid use between the patient populations.