Perioperative anesthesia in children with oncological diseases: prospective single-center continuous cohort study of a 6-year clinical experience

BACKGROUND: Effective anesthesia is one of the most important factors in rapid and successful rehabilitation after surgery. Inadequately selected analgesia and consequent pain significantly slow down the recovery process and are associated with several complications that cover almost all organs and systems and reduce the patient’s quality of life in the long term.

OBJECTIVE: This study aimed to analyze 6 years of clinical experience with perioperative epidural anesthesia in the Research Institute of Pediatric Oncology, considering the effectiveness, safety, and satisfaction of patients and their legal representatives with this medical aid.

MATERIALS AND METHODS: A prospective single-center continuous cohort study was conducted on patients who received epidural analgesia as part of perioperative anesthesia in the period from 2016 to 2021. Data from 702 (48.5%) boys and 745 (51.5%) girls were analyzed. Children were divided into three main groups according to age: from 1 month to 1 year (14.3%), from 1 year to 7 years (37.8%), and from 8 years to 18 years (47.8%). The area of surgical intervention was also considered: abdominal surgery (65.2%), thoracic (8.5%), and orthopedic (26.4%). The choice of the local anesthesia level has also influenced the results. The main study outcomes were the intensity of postoperative pain syndrome in pediatric oncosurgery and additional consumption of narcotic analgesics after the administration of a mixture of topical drugs with or without adjuvants into the epidural space.

RESULTS: The effectiveness of epidural anesthesia in the intraoperative period was quite high, which is confirmed by the stability of hemodynamic parameters. Intraoperatively, additional administration of systemic narcotic analgesics was noted in 5% of the total sample. In all observed patients, epidural adjuvants (morphine and promedol) ensured the optimal duration of action and analgesic efficacy of caudal blockade in the postoperative period; therefore, additional painkillers were not needed. Satisfaction with the intervention was generally high, with 98% providing a rating of “very good” or “good”.

CONCLUSION: Anesthesia methods (epidural blockade), optimal pain control, and active postoperative recovery (including early oral nutrition and mobilization) in fast-track surgery reduce stress reactions and organ dysfunction, significantly reducing the time required for a full recovery.