小儿心脏手术区域麻醉的全国应用模式：胸外科医师协会先天性心脏病手术数据库分析
National practice patterns for the use of regional anesthesia for pediatric cardiac surgery: An analysis of the Society of Thoracic Surgeons congenital heart surgery database.
作者信息
Einhorn Lisa M, Andrew Benjamin Y, Hill Kevin D, Bonnell Levi N, Habib Robert H, Jacobs Marshall L, Jacobs Jeffrey P, Vener David F, Ames Warwick A
机构信息
Department of Anesthesiology, Pediatric Division, Duke University School of Medicine, Durham, NC 27705, USA.
Duke University Pediatric and Congenital Heart Center, Division of Pediatric Cardiology, Durham, NC 27705, USA.
出版信息
J Clin Anesth. 2025 Mar;102:111774. doi: 10.1016/j.jclinane.2025.111774. Epub 2025 Feb 8.
BACKGROUND
Complications associated with suboptimal pain management after pediatric cardiac surgery have increased interest in regional anesthesia (RA). We sought to evaluate national trends and explore the association of RA with postoperative outcomes following pediatric cardiac surgery.
METHODS
Patients <18 years in the Society of Thoracic Surgeons Congenital Cardiac Anesthesia Society Database from 01/2016-05/2023 were analyzed. Non-OR operations and records with missing data on RA were excluded. Data on patients, centers, operations, year, and RA type and medication were collected, and trends over the 8-year study period were analyzed. The association of RA with outcomes was analyzed with multivariable modeling in a subpopulation of children without preoperative risk factors who underwent index atrial and ventricular septal defect (ASD/VSD) repairs and Fontan procedures.
RESULTS
The cohort included 95,514 operations from 62 U.S.
CENTERS
RA was used in 8.4 % (N = 7997) and increased annually from 6.1 % in 2016 to 12.5 % in 2023. Prevalence was highest in cases performed in children 1-11 years, characterized as low risk, and conducted low volume centers. There were statistically significant increases (p < 0.001) in RA use across all age groups and surgical risk categories during the study period. While the number of neuraxial techniques remained constant year-to-year, the number of non-neuraxial techniques (i.e., fascial plane blocks) increased sixfold during the study period. In the sub-analysis cohort (N = 7931), patients with RA for septal defect repairs and Fontan procedures were more likely to be extubated in the OR compared to non-RA patients (p < 0.001). ASD and VSD patients with RA were also more likely to have a short length of stay compared to those without RA (p < 0.001).
CONCLUSIONS
RA use is increasing in pediatric cardiac surgery in the U.S. and may be associated with surgery-specific outcome improvements.
背景
小儿心脏手术后疼痛管理欠佳相关的并发症引发了人们对区域麻醉（RA）的更多关注。我们旨在评估全国范围内的趋势，并探讨RA与小儿心脏手术后的术后结局之间的关联。
方法
对2016年1月至2023年5月胸外科医师协会先天性心脏麻醉学会数据库中年龄小于18岁的患者进行分析。排除非手术室手术和RA数据缺失的记录。收集患者、中心、手术、年份以及RA类型和用药的数据，并分析8年研究期间的趋势。在一个接受初次房间隔和室间隔缺损（ASD/VSD）修补术及Fontan手术且无术前危险因素的儿童亚组中，采用多变量模型分析RA与结局的关联。
结果
该队列包括来自美国62个中心的95514例手术：RA的使用率为8.4%（n = 7997），且从2016年的6.1%逐年增加至2023年的12.5%。患病率在1至11岁儿童进行的手术中最高，这些手术被归类为低风险手术，且由手术量较少的中心实施。在研究期间，所有年龄组和手术风险类别中RA的使用均有统计学显著增加（p < 0.001）。虽然神经轴技术的数量逐年保持不变，但非神经轴技术（即筋膜平面阻滞）的数量在研究期间增加了六倍。在亚分析队列（n = 7931）中，与未使用RA的患者相比，接受RA进行间隔缺损修补术和Fontan手术的患者更有可能在手术室拔管（p < 0.001）。与未使用RA的患者相比，患有ASD和VSD且使用RA的患者住院时间也更短（p < 0.001）。
结论
在美国小儿心脏手术中，RA的使用正在增加，并且可能与特定手术的结局改善相关。
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