90 EPIDURAL VS. WOUND CATHETER IN OPEN PAEDIATRIC PYELOPLASTY
Harmit Ghattaura, Athanasios Tyraskis, Partha Annamalai, Venkatesan Duraiswamy, Laura DeNeumann, Amit Mishra, Jigna Sheth, Varadarajan Kalidasan
The Royal Alexandra Children's Hospital, Brighton, United Kingdom

Abstract
Aims

Epidurals or wound catheters are routinely used post open retroperitoneal pyeloplasty for PUJ obstruction1. There are no studies comparing different positions of wound catheters to epidurals for pain related outcomes in children. We aim to compare efficacy of epidurals to subcutaneous and muscular/transverse abdominis plane (TAP) wound catheters.

Methods

We retrospectively reviewed children who underwent open pyeloplasty at our institution between April 2011 and December 2016. We compared pain scores (0-10 validated rating scale) 2, PCA opiate consumption, and length of stay.  All patients received paracetamol and NSAIDs post-operatively unless contraindicated. Data are stated as median and interquartile range (IQR). Continuous data were compared using a Mann-Whitney test and a P value of 0.05 was considered significant.

Results

42 patients with median age of 8 (3.5m-16yrs) were identified; 6 were excluded as they only had one dose of intra-operative local anaesthetic and 2 patients were excluded due to inadequate documentation. Patients were treated with: epidural (n=7), muscular/TAP (n=9), and subcutaneous wound (n=18) catheters. There was no statistical difference when comparing epidural to each of the wound catheter groups when looking at length of stay and PCA total dosage.
Results are demonstrated in the table as median (IQR).

Conclusion

- We found no significant differences in pain related outcomes when comparing  epidurals to wound catheters suggesting that wound catheters can be used with equal efficacy to epidurals.

- Larger studies/RCTs are needed to confirm our findings.



References
1. Ben-Mier D, Livne PM, Katz J et al. Continuous Epidural versus nonepidural analgesia for post-pyeloplasty pain in children. J Urol 2009 Oct;182(4);1841-1844

2. Castarlenas E, Jensen MP, von Baeyer CL. Psychometric properties of the Numerical Rating Scale to Assess Self-reported pain intensity in children and adults: a systematic review. Clin J Pain. 2017 Apr;33(4):376-383

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