{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:37:17Z","timestamp":1786649837753,"version":"build-2736575974"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"\n Introduction:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Materials and Methods:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Both groups exhibited similar hemodynamic responses, with statistically significant differences in systolic blood pressure at 60 and 72 h (\n P<\/jats:italic>\n < 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.\n <\/jats:p>\n <\/jats:sec>\n \n Discussion:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/aca.aca_25_25","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T16:11:15Z","timestamp":1760371875000},"page":"439-444","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Epidural Analgesic Efficacy of Direct Thoracic versus Caudally Inserted Catheter Positioned in Thoracic Space in Children Undergoing Cardiac Surgery"],"prefix":"10.4103","volume":"28","author":[{"given":"Vipul Krishen","family":"Sharma","sequence":"first","affiliation":[{"name":"Department of Cardiac Anaesthesia, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, (Deemed to be University), Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avirneni","family":"Vaishnavi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anaesthesia, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, (Deemed to be University), Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,10,13]]},"reference":[{"key":"R1-20260420","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.aat.2015.07.002","article-title":"Anesthesia, surgical stress, and \u201clong-term\u201d outcomes","volume":"53","author":"Iwasaki","year":"2015","journal-title":"Acta Anaesthesiol Taiwan"},{"key":"R3-20260420","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1093\/bja\/aer339","article-title":"Risks and benefits of thoracic epidural anaesthesia","volume":"107","author":"Freise","year":"2011","journal-title":"Br J Anaesth"},{"key":"R4-20260420","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1007\/BF03009991","article-title":"Epidural analgesia in children","volume":"41","author":"Berde","year":"1994","journal-title":"Can J Anaesth"},{"key":"R5-20260420","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1097\/00000542-198808000-00020","article-title":"Thoracic epidural anesthesia via caudal route in infants","volume":"69","author":"B\u00f6senberg","year":"1988","journal-title":"Anesthesiology"},{"key":"R6-20260420","doi-asserted-by":"crossref","first-page":"101","DOI":"10.4236\/wjcs.2020.107013","article-title":"(2020) A comparative study on safety and efficacy of caudal, thoracic epidural and intra venous analgesia in paediatric cardiac surgery: A double blind randomised trial\u2014safety and efficacy of regional anesthesia in pediatric cardiac surgeries","volume":"10","author":"Vakamudi","year":"2020","journal-title":"World J Cardiovasc Surg"},{"key":"R8-20260420","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1097\/AAP.0000000000000763","article-title":"Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (fourth edition)","volume":"43","author":"Horlocker","year":"2018","journal-title":"Reg Anesth Pain Med"},{"key":"R9-20260420","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.xjtc.2021.10.040","article-title":"Thoracic epidural anesthesia in congenital heart surgery","volume":"11","author":"Schmehil","year":"2021","journal-title":"JTCVS Tech"},{"key":"R10-20260420","doi-asserted-by":"crossref","first-page":"2118","DOI":"10.12669\/pjms.38.8.6927","article-title":"Effect of TEAS combined with general anesthesia on early postoperative cognitive function in elderly patients undergoing single-port thoracoscopic lobectomy","volume":"38","author":"Chen","year":"2022","journal-title":"Pak J Med Sci"},{"key":"R11-20260420","doi-asserted-by":"crossref","first-page":"1","DOI":"10.33425\/2689-1093.1029","article-title":"Epidural analgesia for pediatric in cardiac surgery","volume":"2","author":"Al Ata Allah","year":"2020","journal-title":"Surg Res"},{"key":"R12-20260420","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1097\/00000542-199606000-00006","article-title":"Thoracic epidural anesthesia via the lumbar approach in infants and children","volume":"84","author":"Blanco","year":"1996","journal-title":"Anesthesiology"},{"key":"R13-20260420","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1097\/00000542-199206000-00010","article-title":"Thoracic epidural anesthesia via the caudal approach in children","volume":"76","author":"Gunter","year":"1992","journal-title":"Anesthesiology"},{"key":"R14-20260420","first-page":"1610","article-title":"A prospective observational study \u2013 epidural catheter insertion site and adequacy of post-operative pain relief in children undergoing thoracic and upper abdominal surgeries","volume":"5","author":"Khan","year":"2018","journal-title":"Indian J Anesth Analg"},{"key":"R15-20260420","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1213\/00000539-200208000-00016","article-title":"Thoracic epidural catheter placement in infants via the caudal approach under electrocardiographic guidance","volume":"95","author":"Tsui","year":"2002","journal-title":"Anesth Analg"},{"key":"R16-20260420","doi-asserted-by":"crossref","first-page":"322","DOI":"10.17085\/apm.21060","article-title":"Real-time ultrasound guided thoracic epidural catheterization: A technical review","volume":"16","author":"Lee","year":"2021","journal-title":"Anesth Pain Med (Seoul)"},{"key":"R17-20260420","first-page":"CD006715","article-title":"Epidural analgesia for adults undergoing cardiac surgery with or without cardiopulmonary bypass","volume":"3","author":"Guay","year":"2019","journal-title":"Cochrane Database Syst Rev"}],"container-title":["Annals of Cardiac Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_25_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:59:00Z","timestamp":1786647540000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_25_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":15,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/aca.aca_25_25","relation":{},"ISSN":["0971-9784","0974-5181"],"issn-type":[{"value":"0971-9784","type":"print"},{"value":"0974-5181","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]},"assertion":[{"value":"2025-02-04","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-11","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}