Postoperative Clinical Course and Opioid Consumption Following Repair of Congenital Diaphragmatic Hernia: Open Versus Thoracoscopic Techniques.

Minimally invasive surgical (MIS) approaches for thoracic procedures in adults result in an improved postoperative course with less pain, but there are limited data on similar procedures in neonates. We aimed to evaluate postoperative opioid consumption and pain management practices in neonates and infants following MIS versus open repair of congenital diaphragmatic hernia (CDH). This was an IRB approved, retrospective study from 2012 to 2016. Demographic data, intraoperative analgesic regimen, total 7-day postoperative opioid consumption, and use of adjunctive pain medications were compared by surgery type (open versus MIS). Secondary measures included time to tracheal extubation, oral feeds, and discharge home. The study cohort included 28 patients (13 female, median age 5 days, average gestational age 39 weeks, and weight 3 kg). MIS was performed in 8 patients. In the first 7 postoperative days, the median postoperative opioid consumption was 0.3 mg/kg of oral morphine equivalents (interquartile range [IQR] 0.2, 18.3) in the MIS group versus 32.3 mg/kg (IQR 9.9, 53.6) in the open group (95% CI of differences in medians: 8.2-42.9;  = .006). No difference was noted in intraoperative opioid administration. Among secondary outcomes, length of stay was significantly longer in the open group. Although several factors may impact the hospital course of neonates with CDH, we found that patients had a more than 100-fold difference in median opioid consumption following repair with MIS versus an open approach. The study also noted significant variation in analgesic regimens suggesting other avenues for improved care of postsurgical neonates.