title: Epidural analgesia improves outcome following pediatric fundoplication. A retrospective analysis.
abstract: OBJECTIVE
  Nissen fundoplication is a common procedure in high-risk pediatric patients. This cohort study evaluated the influence of epidural versus intravenous opioid analgesia on the postoperative course of infants and children undergoing fundoplication.
  
  
  METHODS
  A retrospective review was made of the perioperative courses of 155 consecutive patients, aged 1 month to 19 years, who underwent elective open fundoplication from January 1993 to October 1994. Of these 155 patients, 72 received perioperative analgesia with epidural opioids, while 83 received parenteral opioids. Outcome variables included major morbidity factors, recovery of bowel and bladder function, and economic impact.
  
  
  RESULTS
  Patients in the epidural and parenteral groups did not differ with respect to age, weight, or associated preoperative medical diagnoses. The postoperative complication rate was significantly decreased in the epidural group (5.5% versus 20%) (P < .001). In the epidural group 4 patients required mechanical ventilation for longer than 24 hours, compared with 15 in the parenteral group. Patients in the epidural group were discharged earlier from the hospital and incurred approximately 20% less in hospital charges on average than their cohorts in the intravenous group.
  
  
  CONCLUSIONS
  These findings suggest that perioperative epidural analgesia, administered by a dedicated pain service, amy improve outcome in high-risk pediatric patients undergoing fundoplication.
authors.affiliation: Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, USA.
authors.forename: J K
authors.initials: JK
authors.lastname: McNeely
authors.forename: N E
authors.initials: NE
authors.lastname: Farber
authors.forename: L M
authors.initials: LM
authors.lastname: Rusy
authors.forename: G M
authors.initials: GM
authors.lastname: Hoffman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000191:economics; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D018662:Fundoplication / Q000009:adverse effects / Q000191:economics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007268:Injections, Epidural; D007275:Injections, Intravenous; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid