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A Comparative Study on Safety and Efficacy of Caudal, Thoracic Epidural and Intra Venous Analgesia in Paediatric Cardiac Surgery: A Double Blind Randomised Trial

Introduction:Regional anaesthesia combined 
with general anaesthesia reduces stress response to 
surgery, duration of ventilation, intensive care unit (ICU) stay and promotes early recovery. Studies on 
thoracic epidural, caudal analgesia along with general anaesthesia (GA) in paediatric cardiac surgery are 
limited hence we aimed to compare efficacy 
and safety of caudal, thoracic epidural and intravenous analgesia in 
paediatric cardiac surgery. Methodology: This study was conducted in the 
Department of Anaesthesiology in a tertiary care teaching hospital in southern 
India from February 2019 to December 2019. 90 children were randomised into 
group A, group B, group C. Children in group A received caudal analgesia along 
with GA. Group B children received thoracic epidural along with GA. Group C 
patients received intravenous analgesia along with GA. Rescue analgesia 1 mcg/kg 
fentanyl given in all 3 groups if pain 
score is more than 4. Primary outcome assessed was post-op pain scores. Secondary outcome assessed 
was duration of ventilation, duration of intensive care unit stay. Results: All patients were comparable in terms of age, sex, weight, mean RACHS score, baseline heart rate and blood pressure. Pain 
scores were significantly lower in 
thoracic epidural group compared to other two grou ps. Duration of 
ventilation was lower in thoracic epidural group (91.17± 43.85) minutes and caudal (199.6 ± 723.59) minutes compared to intravenous analgesia 
groups (436.37 ± 705.51) 
minutes. Duration of ICU stay was significantly low in thoracic epidural group 
(2.73 ± 0.69) days compared to 
caudal (3.7 ± 2.8) and 
intravenous analgesia groups (4.33 ± 0.920). We didn’t have any 
complications like hematoma, transient or permanent neurological sequelae in 
regional anesthesia groups. Conclusion: Regional anaesthesia along with general 
anaesthesia was more effective in pain relief than intravenous analgesia with 
general anaesthesia in paediatric cardiac surgery.