Abstract

GA5-101

Pediatric Postoperative Opioid Consumption in Open Versus Thoracoscopic Congenital Diaphragmatic Hernia Repair

Romnek M, Diefenbach K, Tumin D, Tobias J, Thung A, D'Mello A
Nationwide Children's Hospital, Columbus, OH, USA

Introduction: Minimally invasive surgical (MIS) approaches for thoracic procedures in adults are associated with less pain and medication usage, but data in neonates undergoing MIS versus open thoracotomy are lacking. The primary objective of this study was an institutional interrogation and quantification of post-operative opioid consumption and pain management practices in neonates and infants who underwent MIS vs open repair of congenital diaphragmatic hernia (CDH). Secondary objectives included time to extubation, oral feeds and discharge.

Methods: This was an IRB approved, retrospective study using patients’ EMR from 2012-2016 who underwent MIS vs open thoracic surgery for CDH repair. Demographic data included date of birth, age at time of surgery, gestational age, weight, gender, ASA status and co-morbidities. The intraoperative analgesic regimen, total 7 day post-operative opioid consumption, and use of adjunctive pain medications were recorded. Secondary measures consisted of time to extubation, oral feeds and discharge. Continuous data were compared using rank-sum tests while categorical data used Fisher’s exact tests.

Results: 25 patients were identified with 11/14 female/male, median age of 4 days, average gestational age of 39 weeks, and weight of 3 kg. MIS was performed in 5 subjects. In the first 7 postoperative days, median opioid consumption was 0.3 mg/kg of oral morphine equivalents (ME) (interquartile range [IQR]: 0.1,28.1) in the MIS group versus 32.3 mg/kg (IQR: 9.9, 53.6) in the open group (95% CI of differences in medians: 4.3, 43.4 p=0.042). No statistical significance was seen in intraoperative oral ME. Among secondary outcomes, LOS was significantly longer in the open group.

Conclusions: Although several factors may impact the hospital course of neonates with CDH, we found that patients had an over 10-fold median difference in opioid consumption following repair between those who underwent MIS vs open approach. Examination of pain practices of these patients revealed an absence of analgesic regimen standardization resulting in wide variations of opioid administration amongst NICU providers.

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