Thoracic Epidural Analgesia Safe, With High Success in Teens

TOPLINE:

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

METHODOLOGY:

• Researchers conducted an observational retrospective cohort study that included 532 adolescent patients (mean age, 15 years) who underwent chest wall surgery at a high-volume academic medical center in Belgium.
• All operations were for the correction of concave or pigeon chest.
• Board-certified anesthesiologists or senior anesthesiology residents placed epidural catheters at levels T5-T6, T6-T7, or T7-T8. Patients received a bolus dose of 0.25% levobupivacaine at 0.1 mL/kg at the start and end of the surgery, followed by low-dose continuous 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 emerging from general anesthesia (or after top-up) and no need for rescue analgesics.

TAKEAWAY:

• TEA provided adequate postoperative pain relief in 81% of cases.
• About 60% patients experienced one or more minor acute adverse events, but no long-term complications occurred.
• Late-onset 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%), difficult insertion (4%), paresthesia (2%), and bloody punctures (2%).
• Short-term events included Horner’s syndrome (2%), which resolves after removal of TEA, 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 in order. The length of hospital stay is a cause for concern and may 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 University Hospitals Leuven, Leuven, Belgium. It was published online on October 4, 2024, in the European Journal of Anaesthesiology.

LIMITATIONS:

The study’s retrospective design may have introduced information and selection bias. The cohort included insufficient patients to identify rarer but potentially serious complications like epidural hematomas. The study’s findings may not be reproducible in centers with a lower caseload of thoracic epidurals.

DISCLOSURES:

The study did not receive any specific funding. One author reported receiving funding for webinars, workshops, and lectures from medical technology and health solution companies and research grants for past research projects.

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