Infant lumbar and thoracic epidurals for abdominal surgeries: cases in a paediatric tertiary institution.

INTRODUCTION There is strong evidence that epidural analgesia provides good postoperative pain relief in adults, but its use in infants is less established. In this retrospective study, we present our experience with managing infant epidural analgesia for abdominal surgeries in a tertiary paediatric institution. METHODS The records of 54 infants who had received a thoracic or lumbar epidural as perioperative analgesia for abdominal surgeries were included. The mean age of the infants was 6.1 (standard deviation [SD] 3.8) months and their mean weight was 6.8 kg (SD 1.8). Most (63%) had an ASA (American Society of Anesthesiologists) status of 2 and all underwent elective gastrointestinal, urogenital, hepatobiliary or retroperitoneal surgeries. 20 catheters (37.0%) were inserted in the thoracic region and 33 (61.1%) in the lumbar region. RESULTS A total of 52 (96.3%) catheters provided adequate intraoperative analgesia and 36 (66.7%) provided effective analgesia for the postoperative period. Active management of epidural analgesia, such as through epidural top-ups and infusion rate adjustment, was necessary to optimise analgesia in 22 (44%) of the 50 patients postoperatively. Reasons for premature catheter removal were mainly technical issues such as catheter disconnection, leakage and blockage. CONCLUSION Our data suggests that in experienced hands, specialised settings and active management, the success rate of epidural analgesia in infants undergoing major abdominal surgeries is high and without major incident.

[1]  T. Bhalla,et al.  Combined use of neuraxial and general anesthesia during major abdominal procedures in neonates and infants , 2014, Paediatric anaesthesia.

[2]  B. Ilfeld Continuous Peripheral Nerve Blocks: A Review of the Published Evidence , 2011, Anesthesia and analgesia.

[3]  T. Dolfin,et al.  Continuous lumbar/thoracic epidural analgesia in low-weight paediatric surgical patients: practical aspects and pitfalls , 2009, Pediatric Surgery International.

[4]  A. Ganesh,et al.  Efficacy of Addition of Fentanyl to Epidural Bupivacaine on Postoperative Analgesia after Thoracotomy for Lung Resection in Infants , 2008, Anesthesiology.

[5]  R. Howard,et al.  Clinical signs of infection during continuous postoperative epidural analgesia in children: the value of catheter tip culture , 2004, Paediatric anaesthesia.

[6]  K. Thies,et al.  Subcutaneous Tunneling of Caudal Catheters Reduces the Rate of Bacterial Colonization to That of Lumbar Epidural Catheters , 2004, Anesthesia and analgesia.

[7]  B. Tsui,et al.  Thoracic and Lumbar Epidural Analgesia via the Caudal Approach Using Electrical Stimulation Guidance in Pediatric Patients: A Review of 289 Patients , 2004, Anesthesiology.

[8]  John A. Cowan,et al.  Efficacy of postoperative epidural analgesia: a meta-analysis. , 2003, JAMA.

[9]  R. Sümpelmann,et al.  Postoperative analgesia in infants and children , 2003, Current opinion in anaesthesiology.

[10]  B. Tsui,et al.  Thoracic epidural catheter placement via the caudal approach in infants by using electrocardiographic guidance. , 2002, Anesthesia and analgesia.

[11]  A. Bosenberg Epidural analgesia for major neonatal surgery. , 1998 .

[12]  N. Farber,et al.  Culture of Bacteria From Lumbar and Caudal Epidural Catheters Used for Postoperative Analgesia in Children , 1996, Regional Anesthesia & Pain Medicine.

[13]  F. Vidal,et al.  Thoracic Epidural Anesthesia Via the Lumbar Approach in Infants and Children , 1996, Anesthesiology.

[14]  R. Filler,et al.  THe significance of fever following operations in children. , 1982, Journal of pediatric surgery.

[15]  H. Gramke,et al.  Evaluation of two different epidural catheters in clinical practice. narrowing down the incidence of paresthesia! , 2007, Acta anaesthesiologica Belgica.

[16]  T. Voepel-Lewis,et al.  The FLACC: a behavioral scale for scoring postoperative pain in young children. , 1997, Pediatric nursing.