Related Experiment Videos
Epidural analgesia in children with cerebral palsy
B R Brenn1, R P Brislin, J B Rose
1Department of Anesthesiology, Alfred I. duPont Hospital for Children, Wilmington, DE 19899, USA. brbrenn@nemours.org
Insights
Continuous epidural infusion of bupivacaine and fentanyl offers effective pain relief for children with cerebral palsy (CP). Intermittent epidural morphine is linked to excessive sedation and should be avoided in this patient group.
Area of Science:
- Pediatric Anesthesiology
- Neurology
- Pain Management
Background:
- Cerebral palsy (CP) presents unique challenges for pain management.
- Epidural analgesia is a common method for postoperative pain control in children.
Purpose of the Study:
- To compare the efficacy and safety of two epidural analgesia modalities in children with CP.
- To assess the incidence of complications associated with different epidural techniques in CP patients.
Main Methods:
- A comparative study involving 92 children with CP undergoing infra-umbilical orthopedic or Nissen fundoplication procedures.
- Patients received either intermittent bolus (IB) epidural morphine or continuous infusion (CI) of bupivacaine and fentanyl.
- Data on analgesia and complications were collected and analyzed for two CP types (spastic diplegia and quadriplegia) and two analgesia modalities.
Main Results:
- Excellent analgesia was achieved in 91% of patients.
- Excessive sedation occurred significantly more in the IB morphine group (P < 0.02).
- Vomiting and pruritus were more common in diplegic CP patients compared to quadriplegic patients (P < 0.01 and P < 0.001, respectively).
Conclusions:
- Continuous infusion epidural analgesia with bupivacaine and fentanyl provides effective pain management for children with CP.
- Intermittent bolus epidural morphine is associated with a high rate of excessive sedation and is not recommended for CP patients.
- Epidural analgesia can be safely used in children with CP, with careful consideration of the chosen modality.
Purpose:
Two modalities of epidural analgesia in children with two types of cerebral palsy (CP) were compared for differences in the incidence of common complications (inadequate analgesia, hypopnea, hypoxaemia, sedation, vomiting, pruritus, urinary retention, and seizures).
Methods:
Demographic, procedural and postoperative complication data were collected on children with CP receiving epidural analgesia. Information was recorded contemporaneously with the child's care by one of the authors on 92 consecutive children with CP (age, 107 +/- 50.1 mo; weight, 26 +/- 14.2 kg) who had undergone infra-umbilical orthopaedic or Nissen fundoplication procedures between December 1994 and December 1996. The first 44 patients received intermittent bolus (IB) epidural morphine and the next 48 received continuous infusion (CI) bupivacaine and fentanyl. Two forms of CP (spastic diplegia and quadriplegia) and the two modalities of analgesia were compared.
Results:
Excellent analgesia was obtained in 91/92 patients. Excessive sedation occurred in six patients (6.5%) but only in IB patients, (P < 0.02 vs CI). Emesis occurred in 52% of patients, and was more common in diplegic than in quadriplegic patients (68% vs 38%, P < 0.01). Pruritus was observed in 29% of patients and was more common in diplegia than quadriplegia (48% vs 12.5%, P < 0.001). The incidences of hypopnea, hypoxaemia, urinary retention and seizures were not affected by the types of CP or analgesia and no difference in sedation was observed between spastic diplegic and quadriplegic patients.
Conclusions:
Continuous infusion of epidural bupivacaine and fentanyl provided excellent analgesia for children with CP without serious complications. Intermittent bolus epidural morphine was associated with a high incidence of excessive sedation and should be avoided in this population.