Clinical outcomes of a standardised enhanced recovery after surgery protocol, including thoracic epidural analgesia, were studied in children undergoing trans-atrial cardiac surgery via the right mid-axillary thoracotomy approach.

This single-centre retrospective study examined 42 paediatric patients who underwent trans-atrial cardiac surgeries via the mid-axillary approach (2018 to 2020), of whom 30 received epidural catheters. The standardised enhanced recovery after surgery protocol included transesophageal echo-guided thoracic epidural catheter placement, multimodal analgesia, reduced opioid use, and planned early extubation and discharge. Clinical outcomes assessed included extubation times, postoperative analgesic requirements, ICU pain scores, hospital length of stay, and any complications related to regional anaesthesia or surgery.

Thirty patients received an epidural placed between the third and sixth thoracic interspace levels under transesophageal ultrasonography guidance. The median age was 42 months (range 3–156), and the median weight was 15.7 kg (range 4.9–61 kg). Epidural infusions were continued for a median of 52 hours postoperatively. The intraoperative fentanyl usage was a median of 4.5 mcg/kg (interquartile range (IQR) 2–9). Intraoperative extubation was achieved in 28 of the 30 patients. Median post-extubation pain scores in the first 6 and 12 hours were 0 (IQR 0), and postoperative rescue opioid requirements were low in epidural patients. There were no instances of tracheal reintubation, neuraxial blockade-related complications, or other anaesthesia-related adverse events.

Through our standardised and reproducible anaesthetic protocol, we achieved excellent and nearly pain-free recovery in paediatric patients undergoing trans-atrial cardiac surgeries via the mid-axillary approach.