• Lisa M Einhorn, Benjamin Y Andrew, Derek A Nelsen, and Warwick A Ames.
• Department of Anesthesiology, Duke University Medical Center, Durham, NC. Electronic address: lisa.einhorn@duke.edu.
• J. Cardiothorac. Vasc. Anesth. 2022 Nov 1; 36 (11): 405440614054-4061.

ObjectiveThe objective of this study was to determine whether the use of regional anesthesia in children undergoing congenital heart surgery was associated with differences in outcomes when compared to surgeon-delivered local anesthetic wound infiltration.DesignA retrospective cohort study.SettingAt a single pediatric tertiary care center.ParticipantsPediatric patients who underwent primary repair of septal defects between January 1, 2018, and March 31, 2022.InterventionsThe patients were grouped by whether they received surgeon-delivered local anesthetic wound infiltration or bilateral pectointercostal fascial blocks (PIFBs) and a unilateral rectus sheath block (RSB) on the side ipsilateral to the chest tube.Measurements And Main ResultsUsing overlap propensity score-weighted models, the authors examined postoperative opioid requirements (morphine milliequivalents per kilogram), pain scores, length of stay, and time under general anesthesia (GA). Eighty-nine patients were eligible for inclusion and underwent analysis. In the first 12 hours postoperatively, the block group used fewer morphine equivalents per kilogram versus the infiltration group, 0.27 ± 0.2 v 0.64 ± 0.42, with a weighted estimated decrease of 0.39 morphine equivalents per kilogram (95% CI -0.52 to -0.25; p < 0.001), and had lower pain scores, 3.2 v 1.6, with a weighted estimated decrease of 1.7 (95% CI -2.3 to -1.1; p < 0.001). The length of stay and time under GA also were shorter in the block group with weighted estimated decreases of 22 hours (95% CI -33 to -11; p = 0.001) and 18 minutes (95% CI -34 to -2; p = 0.03), respectively.ConclusionsBilateral PIFBs and a unilateral RSB on the side ipsilateral to the chest tube is a novel analgesic technique for sternotomy in pediatric patients. In this retrospective study, these interventions were associated with decreases in postoperative opioid use, pain scores, and hospital length of stay without prolonging time under GA.Copyright © 2022 Elsevier Inc. All rights reserved.

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