National practice patterns for the use of regional anesthesia for pediatric cardiac surgery: An analysis of the Society of Thoracic Surgeons congenital heart surgery database

Background: Complications associated with suboptimal pain management after pediatric cardiac surgery have increased interest in regional anesthesia (RA). We sought to evaluate national trends and explore the association of RA with postoperative outcomes following pediatric cardiac surgery. Methods: Patients <18 years in the Society of Thoracic Surgeons Congenital Cardiac Anesthesia Society Database from 01/2016-05/2023 were analyzed. Non-OR operations and records with missing data on RA were excluded. Data on patients, centers, operations, year, and RA type and medication were collected, and trends over the 8year study period were analyzed. The association of RA with outcomes was analyzed with multivariable modeling in a subpopulation of children without preoperative risk factors who underwent index atrial and ventricular septal defect (ASD/VSD) repairs and Fontan procedures. Results: The cohort included 95,514 operations from 62 U.S. centers. RA was used in 8.4 % (N = 7997) and increased annually from 6.1 % in 2016 to 12.5 % in 2023. Prevalence was highest in cases performed in children 1-11 years, characterized as low risk, and conducted low volume centers. There were statistically significant increases (p <0.001) in RA use across all age groups and surgical risk categories during the study period. While the number of neuraxial techniques remained constant year-to-year, the number of non-neuraxial techniques (i. e., fascial plane blocks) increased sixfold during the study period. In the sub-analysis cohort (N = 7931), patients with RA for septal defect repairs and Fontan procedures were more likely to be extubated in the OR compared to non-RA patients (p < 0.001). ASD and VSD patients with RA were also more likely to have a short length of stay compared to those without RA (p < 0.001). Conclusions: RA use is increasing in pediatric cardiac surgery in the U.S. and may be associated with surgery- specific outcome improvements.