Introduction The use of thoracic epidural is standard in adult
thoracotomy patients facilitating earlier mobilization, deep breathing, and minimizing
narcotic effects. However, a recent randomized trial in pediatric patients who undergo repair of
pectus excavatum suggests
patient-controlled analgesia (PCA) produces a less costly, minimally invasive postoperative course compared with epidural. Given that
thoracotomy is typically less painful than pectus bar placement, we compared the outcomes of epidural to PCA for
pain management after pediatric
thoracotomy. Methods A retrospective review of 17 oncologic
thoracotomies was performed at a children's hospital from 2004 to 2013. Data points included operative details, epidural or PCA use, urinary catheterization, days to regular diet, days to oral
pain regimen,
postoperative pain scores,
length of stay, and
anesthesia charges. Patients were excluded if they did not have epidural or PCA following
thoracotomy. Results Six
thoracotomies were managed with an epidural and 11 with a PCA. Three epidural patients were
opiate naïve compared with two with a PCA. The most common indication for
thoracotomy was metastatic
osteosarcoma (n = 13). When comparing epidural to PCA, there was no significant difference in days to removal of Foley
catheter, regular diet, oral
pain control,
length of stay, or total operating room time.
Postoperative pain scores were also comparable. The mean
anesthesia charges were significantly higher in patients with an epidural than with a PCA. Conclusion Epidural
catheter and PCA provided comparable
pain relief and objective recovery course in children who underwent
thoracotomy for oncologic disease; however, epidural
catheter placement was associated with increased
anesthesia charges, suggesting that PCA is a noninvasive, cost-effective alternative.