Non-analgesic benefits of combined thoracic epidural analgesia with general anesthesia in on-pump pediatric cardiac surgery: A prospective observational study

Alok Kumar; Ravi Kapoor; Shubham Mishra; Ankur Joshi; Nikhil Tiwari; H R Ramamurthy

doi:10.1016/j.mjafi.2023.01.006

Non-analgesic benefits of combined thoracic epidural analgesia with general anesthesia in on-pump pediatric cardiac surgery: A prospective observational study

Med J Armed Forces India. 2024 Jan-Feb;80(1):80-90. doi: 10.1016/j.mjafi.2023.01.006. Epub 2023 Apr 10.

Authors

Alok Kumar¹, Ravi Kapoor², Shubham Mishra³, Ankur Joshi⁴, Nikhil Tiwari⁵, H R Ramamurthy⁶

Affiliations

¹ Senior Advisor (Anesthesia & Cardiothoracic Anaesthesia), Army Hospital (Research & Referral), New Delhi, India.
² Classified Specialist (Biochemistry), Army Hospital (Research & Referral), New Delhi, India.
³ Resident (Anaesthesia), Army Hospital (Research & Referral), New Delhi, India.
⁴ Classified Specialist (Anaesthesia & Cardiothoracic Anaesthesia), Army Hospital (Research & Referral), New Delhi, India.
⁵ Consultant (Surgery) & Cardiothoracic Surgeon, Army Institute of Cardiothoracic Sciences, Pune, India.
⁶ Senior Advisor (Paediatrics) & Trained in Paediatric Cardiology, Army Hospital (Research & Referral), New Delhi, India.

PMID: 38261822
PMCID: PMC10793232 (available on 2025-01-01)
DOI: 10.1016/j.mjafi.2023.01.006

Abstract

Background: The use of thoracic epidural analgesia in infants and children could attenuate the stress response and thereby improve the outcomes associated with cardiac surgery.

Methods: This study is a prospective observational study conducted on 118 patients admitted for cardiac surgery. All patients received thoracic epidural analgesia. Laboratory investigations including inflammatory markers, markers for different organ functions, and intensive care unit parameters were collected at different time points (preoperative, immediate postoperative, on day 1, and day 2).

Results: Inflammatory markers such as IL6, IL8, and metabolic response as measured by serum cortisol and blood sugar were significantly high in the immediate postoperative period, which later stabilized in the next 48 h. There was also a sharp increase in the anti-inflammatory marker IL-10 in an immediate postoperative period, which settled later on but continued to be higher than baseline in the next 48 h. All these markers showed lower values when compared to published literature. The baseline renal oxygen saturation using near infrared spectroscopy (NIRS) value in our study was 59.3 + 19, which increased to 76.4 + 12.7 on day 2. Serum neutrophil gelatinase associated lipocalin (NGAL) remained well below normal levels in the perioperative period. PF (pO2/FiO2) ratio and pO2 consistently improved postoperatively with the maximum on day 2. The median mechanical ventilation (MV) duration was 18 h, and the mean length of stay that included intensive care unit stay was 12 days. No epidural-related adverse events were noted.

Conclusions: Apart from good analgesia, patients receiving thoracic epidural analgesia displayed a reduction in perioperative stress, superior postoperative glycemic control, reduction in inflammatory markers, postoperative acute kidney injury, and pulmonary complications.

Keywords: Congenital heart surgery; Cytokines; Epidural analgesia; Inflammatory markers; Length of stay.