191
11–14 APRIL, 2018, HELSINKI, FINLAND
13:11–13:14
S26-5 (PP)
EPIDURAL ANALGESIA DECREASES NARCOTIC
REQUIREMENTS IN LOW LEVEL SPINA BIFIDA PATIENTS
Joshua ROTH
1
, Rosalia MISSERI
1
, Stephanie WHITTAKER
2
, Francesca MONN
3
, Aali
SHAH
2
, Nicole HORN
2
, Mark CAIN
1
and Morton GREEN
2
1) Riley Hospital for Children, Urology, Indianapolis, USA - 2) Riley Hospital for Children, Anesthesia, Indianapolis,
USA - 3) Indiana University Health, Urology, Indianapolis, USA
PURPOSE
Epidural analgesia use in low level spina bifida patients (LLSB) during labor and delivery has been
reported, however, its post-operative use has not been studied or reported. We hypothesize that
thoracic epidural placement in the T9-T10 interspace is safe and decreases narcotic requirements
in LLSB following open lower urinary tract reconstruction (LUTR).
MATERIAL AND METHODS
We retrospectively reviewed consecutive LLSB who had LUTR and received epidurals at our
institution from 4/16 to 10/17. We matched controls with LLSB who received tap blocks with similar
procedures from 12/13–10/17. Ropivicaine 0.2 % was infused at a rate of 0.4 mg/kg/hr in epidurals.
Patients received prn diazepam, acetaminophen, ketorolac and either IV narcotics or a patient
controlled analgesia (PCA) pump. Opioid consumption was calculated utilizing equivalent IV mor-
phine doses. Mean and maximum pain scores on post-operative day (POD) 0–3 were calculated.
Descriptive statistics were performed.
RESULTS
10 LLSB who had LUTR and epidurals were matched to 10 LLSB who had LUTR and tap blocks at
our institution. Groups were demographically similar. All had full abdominal sensation and functional
levels at or below L3. Pain scores were the same or improved in the epidural group. The epidural
group had decreased opioid consumption on POD 0–3 (0.80 mg/kg vs. 1.50 mg/kg, p=0.026). No
epidural complications or changes in functional status were noted.
Patients with epidurals had significantly lower overall narcotic requirements when adjusting for age
and PCA availability (p=0.042). Patients with a PCA used more narcotics when adjusting for age
and epidural (0.029).
CONCLUSIONS
Thoracic epidural analgesia is a safe and effective option to assist with post-operative pain manage-
ment following LUTR in LLSB.