Effect of Epidural Anaesthesia on Postoperative Neutrophil-to-Lymphocyte Ratio in Paediatric Cardiac Surgery: A Retrospective Cohort Study.

BACKGROUND

Paediatric cardiac surgery patients are prone to a systemic inflammatory response on cardiopulmonary bypass. Regional and epidural anaesthesia suppresses an unbalanced hyperinflammatory response generated due to the interplay within the neuro-endocrine-immune network. Regional and epidural anaesthesia reduces the inflammatory response. This study evaluated the effect of thoracic epidural anaesthesia (TEA) on the neutrophil-to-lymphocyte ratio (NLR), a marker for inflammation.

METHOD: This was a retrospective, observational cohort study of paediatric cardiac surgery patients conducted at a tertiary care hospital between January 2024 and June 2024. A total of 52 paediatric patients aged 1-12 years were included. The patients were categorized into TEA with general anaesthesia (TEA-GA) and isolated general anaesthesia (GA) groups. Patients in the TEA-GA group (n = 26) were compared to the isolated GA group (n = 26) for the primary outcome of NLR at 24 hours postoperatively. The secondary outcomes of the study were extubation within six hours, ventilation duration, ICU stay, postoperative stay in the hospital (PLoS), time to initiate oral intake, and arterial blood gas (ABG) parameters at the time of extubation.

MEASUREMENTS AND MAIN

RESULTS

Baseline characteristics, including age, gender, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) score, and bypass time, were comparable between the groups. Although there was a 10-fold rise in NLR from baseline to 24-hour postoperative time, there was no significant difference in NLR at 24 hours (TEA-GA group: median = 10.75, IQR = 9.85-11.8 vs. GA group: median = 7.37, IQR = 4.45-13.95; p = 0.56). There were no significant differences in the secondary outcomes, except partial pressure of arterial carbon dioxide (31.59 ± 4.05 in the TEA-GA group vs. 34.0 ± 4.5 in the GA group; p < 0.05).

CONCLUSION

According to this study, TEA-GA may not affect postoperative NLR compared to GA alone in paediatric cardiopulmonary bypass.