Effect of Intraoperative Regional Anesthesia on Postoperative Outcomes in Pediatric Cardiac Surgery-A Systematic Review of Randomized Controlled Trials.

OBJECTIVE

To conduct a meta-analysis of postoperative outcomes following the use of regional anesthesia in pediatric cardiac surgery.

DATA SOURCES: We searched PubMed (MEDLINE), Web of Science, CINAHL, CENTRAL, and Scopus in December 2024 (PROSPERO: CRD420025635423; registered January 2025).

STUDY SELECTION: Two authors screened search results. We included parallel-grouped randomized controlled trials (RCT) regardless of blinding. Studies comparing adjuvant regional anesthesia (excluding neuraxial anesthesia) with general anesthesia in pediatric patients (0-17 years) having cardiac surgery via midline sternotomy were included.

DATA EXTRACTION: Two authors independently extracted the data and assessed risk of bias. The main outcome measures were pain relief using any documented pain score and duration of mechanical ventilation. Other outcome measures sought were postoperative opioid consumption, time to first rescue analgesia, time in pediatric intensive care unit (PICU), length of hospital stay, complications, and patient satisfaction.

DATA SYNTHESIS: We identified 15 RCTs with 1055 participants for the analysis. Pain scores were lower during the first 24 h postoperatively, with Modified Objective Pain Scale (MOPS) mean difference (MD) being 0.76 less (MD -0.76; CI -1.19 to -0.32). Duration of mechanical ventilation was 48 min shorter in the regional anesthesia group (MD -48; CI -60 to -36). Postoperative cumulative opioid consumption (morphine equivalents) was 0.21 mg/kg lower (MD -0.21; CI -0.30 to -0.11). No complications related to regional anesthesia were reported.

CONCLUSIONS

Our meta-analysis demonstrates that regional anesthesia in pediatric cardiac surgery reduces postoperative pain, as measured by pain scores and postoperative opioid consumption, leads to shorter mechanical ventilation and PICU stays.