Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States of America; Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States of America; Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
J Clin Anesth. 2021 Sep;72:110314. doi: 10.1016/j.jclinane.2021.110314. Epub 2021 Apr 22.
Our study sought to audit our institutional practice of routine single-shot caudal epidural hydromorphone injection in children undergoing congenital cardiothoracic surgery to assess perioperative pain control and evaluate for any caudal complications.
Retrospective observational study of all patients that received a caudal hydromorphone injection as part of the anesthetic for their cardiac surgical operation between January 2017 and July 2019.
Pediatric Cardiothoracic Operating Room (OR), Cardiac Intensive Care Unit.
One hundred and twenty-seven patients that received caudal hydromorphone as part of their anesthetic for a cardiac surgical operation.
Caudal epidural injection performed immediately following induction of anesthesia utilizing only hydromorphone.
The primary outcome was well-controlled pain, defined as a score of <4/10 on rFLACC or verbal pain scoring. Secondary outcome measures included in-OR extubation, pain service duration (from first assessment to "sign-off"), complications related to the caudal block, intensive care unit (ICU) length of stay (LOS), and Hospital LOS.
One hundred and nine patients were included in the final analysis. Pain was "well-controlled" on average in 96.3% of patients (105/109). Average pain in the 24-h post-block period was 1.67 (SD = 2.37), with median pain score of 0 [0-3]. Peak pain score remained <4/10 for the entire 24-h post-block period in 22% of patients. 77.1% of caudal hydromorphone patients were extubated in the operating room. The median time to heparinization post-block was 108 min, beyond the ASRA recommendation of 60 min for neuraxial procedures. There were two caudal-related complications: one subcutaneous injection, and one instance of a time to heparinization of less than 60 min (56 min). Neither caudal complication led to patient harm.
Caudal hydromorphone injection can safely contribute to achieving "well-controlled" pain in the pediatric cardiac surgical population when used as a component of a perioperative pain control plan.
本研究旨在对我院小儿心胸外科手术中常规单次骶管硬膜外注射氢吗啡酮的实践进行审核，以评估围手术期疼痛控制情况，并评估有无骶管相关并发症。
对 2017 年 1 月至 2019 年 7 月期间接受心脏手术麻醉的所有接受骶管氢吗啡酮注射的患者进行回顾性观察性研究。
小儿心胸外科手术室（OR），心脏重症监护病房（CICU）。
127 名接受心脏手术麻醉的患者接受了骶管氢吗啡酮注射。
在麻醉诱导后立即进行单次骶管硬膜外注射，仅使用氢吗啡酮。
主要结果为疼痛控制良好，定义为 rFLACC 或口头疼痛评分<4/10。次要结果包括在手术室（OR）拔管、疼痛服务时长（从首次评估到“签字确认”）、与骶管阻滞相关的并发症、重症监护病房（ICU）住院时长（LOS）和住院时长（LOS）。
109 例患者最终纳入分析。平均 96.3%（105/109）的患者疼痛“控制良好”。术后 24 小时内平均疼痛为 1.67（标准差 2.37），中位数疼痛评分为 0[0-3]。22%的患者术后 24 小时内的峰值疼痛评分仍<4/10。77.1%的接受氢吗啡酮骶管阻滞的患者在手术室拔管。术后阻滞至肝素化中位时间为 108 分钟，超过 ASRA 推荐的 60 分钟用于神经轴突手术的时间。有 2 例骶管相关并发症：1 例皮下注射，1 例肝素化时间<60 分钟（56 分钟）。这 2 例骶管并发症均未导致患者损害。
在小儿心胸外科手术患者中，当氢吗啡酮骶管注射作为围手术期疼痛控制方案的一部分时，可以安全地实现“良好控制”的疼痛。
