Abstract
INTRODUCTION: Effective pain management during paediatric cardiac surgery is essential to prevent complications such as metabolic, neuroendocrine, and immunological disturbances. Thoracic epidural anesthesia (TEA) offers significant benefits in terms of pain relief and postoperative recovery. However, its application in children is challenging due to the risk of dural puncture and nerve injury. This study compares the efficacy of two techniques: direct thoracic space insertion and caudal-to-thoracic space catheter placement for TEA in pediatric cardiac surgery. MATERIALS AND METHODS: This prospective, randomized study was conducted at a tertiary center with 40 children undergoing elective cardiac surgery. Participants were randomized into two groups: Group A (Direct Thoracic Space) and Group B (Caudal-to-Thoracic Space). Epidural catheter insertion was followed by a bolus of bupivacaine and morphine, and continuous infusion for postoperative pain control. Hemodynamic parameters, Face, Legs, Activity, Cry, Consolability (FLACC) scores for pain, and analgesic requirements were monitored. RESULTS: Both groups exhibited similar hemodynamic responses, with statistically significant differences in systolic blood pressure at 60 and 72 h (P < 0.05) favoring the Direct Thoracic group. Postoperative pain control, assessed using FLACC scores, was marginally better in Group A, but differences were not statistically significant. No major complications were observed. DISCUSSION: While both methods provided comparable analgesia and hemodynamic stability, the direct thoracic approach was slightly more effective in pain management. The caudal to thoracic method remains technically simpler and more accessible, making it a viable alternative. CONCLUSION: Both techniques provide effective analgesia, with no major complications. The caudal to thoracic approach offers a safer, simpler alternative to direct thoracic catheter placement in pediatric cardiac surgery.