Multimodal postoperative pain management including epidural analgesia for primary bladder exstrophy repair

Abstract

Background: Classic bladder exstrophy is a major birth defect requiring complex reconstructive surgery and complex postoperative care and pain management. The hospital recovery is lengthy (four to six weeks) and is accompanied by the challenges of caring for young children and infants needing pain management, strict bed rest, and nutritional care that allows for wound healing.

Methods: In this paper, we review the literature and offer the experiences of a high-volume centre of excellence for bladder exstrophy care. We provide recommendations for epidural catheter placement, catheter tunnelling, postoperative care, and maintenance. We provide guidelines for multimodal medication management strategies and postoperative nutrition requirements.

Conclusions: The goals of care include 1) providing pain management to address incisional pain and bladder spasms and to protect the surgical repair and promote healing by reducing pelvic motion and constipation-associated straining; 2) promoting a successful pulmonary recovery; and 3) optimising nutrition for wound healing. Multimodal pain management using a combination of regional analgesia and oral/intravenous (IV) medications is needed for this challenging patient population. Care is intense and requires an experienced and dedicated interprofessional team.