• Kerry McLaughlin, Alex Konstantatos, Shravya Karna, Stuart Azzopardi, Mark Buckland, Harry Sivakumar, Ron Glick, Mycah Astrera-Srgo, and Eldho Paul.
• Alfred Hospital, Melbourne, Victoria, Australia.
• Reg Anesth Pain Med. 2024 Sep 11.

BackgroundThe value of epidural analgesia in pediatric patients having heart and lung transplant surgery is unknown. We aimed to characterize various quality outcomes in patients who did and did not have epidural analgesia.MethodsData were collected retrospectively for 62 patients from 2006 to 2023 at a tertiary care transplant center. Patients were evaluated by epidural status. The primary outcome was a hospital stay in days. Other measures of morbidity and mortality were measured as secondary endpoints.ResultsThe mean age was 12.7 (3) years; 54 (87%) received bilateral lung transplantation, and 8 (13%) received en bloc heart-lung transplantation. 41 (66%) were female. Epidural utilization rate was 74 %, n=45. On univariate analysis, epidural analgesia compared with no epidural was associated with a reduction in the median length of hospital stay from 26.5 to 20 days (p=0.02). After adjustment for age, sex and type of operation, there was no significant difference in LOS. Other findings following univariate analysis included reduced time of postoperative ventilation with a median reduction of 7-2 days (p=0.019), and a reduced 5-day postoperative opioid requirement; median of 2.94-1.21 mg/kg/24 hours (p=0.004) with epidural analgesia. Epidural analgesia was not associated with a change in overall survival (p=0.49).ConclusionDespite a likely improvement in analgesia, we could not demonstrate a definitive impact of epidural analgesia on outcomes in this small cohort of patients. Larger datasets through registries and institutional collaboration will be needed to increase sample size to identify effect sizes and adjust for confounders.© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.

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