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Retrospective evaluation of continuous epidural infusion for postoperative pain in children
L Jylli1, S Lundeberg, G L Olsson
1Paediatric Anesthesia and Intensive Care, Acute Pain Treatment Service, Astrid Lindgren Children's Hospital, Karolinska Hospital, Sweden. leena.jylli@ks.se
Insights
Postoperative epidural analgesia (EDA) in children provided good pain relief in 76% of cases with no major complications. Early recognition of issues is key for effective pediatric pain management.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Surgical Care
Background:
- Limited data on the safety and efficacy of postoperative epidural analgesia (EDA) in children.
- Need for comprehensive evaluation in routine postoperative care settings.
Purpose of the Study:
- Evaluate pain relief efficacy of EDA in children.
- Determine incidence and types of complications.
- Identify factors influencing EDA efficacy.
Main Methods:
- Retrospective study of 518 epidural infusions in 476 children (1994-1999).
- Daily data collection on analgesia, complications, and surgery details.
- Analysis of factors affecting pain relief and complications.
Main Results:
- 76% of visits reported good pain relief.
- No major complications or sequelae observed.
- 37% of infusions discontinued prematurely, 21% due to inadequate analgesia.
Conclusions:
- Continuous epidural infusion is generally satisfactory for pediatric postoperative pain.
- No major adverse events occurred in children on regular wards.
- Prompt identification of unsatisfactory analgesia is crucial for patient well-being.
Background:
The safety and efficacy of postoperative epidural analgesia (EDA) in children are not well documented in larger series of patients given routine postoperative care. The aims of this study were to evaluate the efficacy of pain relief, determine the incidence and type of complications during the entire period of epidural pain treatment in children, and assess the factors affecting efficacy
Methods:
Children treated postoperatively with an EDA infusion during the period 18 September 1994 to 1 January 1999 were studied. Data regarding the age, gender, efficacy of analgesia, duration of epidural infusion, types of side-effects and complications, reasons for discontinuation, and types and duration of surgery were collected daily by the Acute Pain Treatment Service. The sensory dermatomal level of the surgical incision site was included retrospectively.
Results:
Five hundred and eighteen epidural infusions were given to 476 children. Pain relief was rated as 'good' at 76% of visits. There were no major complications or sequelae. Thirty-seven per cent of the epidural infusions were prematurely discontinued, and 21% were discontinued because of unsatisfactory analgesia. Factors related to a higher percentage of unsatisfactory function were surgical incision site located above the umbilicus, gastroenterologic surgery, protracted surgery and age. Age and duration of surgery were significantly related to unsatisfactory function.
Conclusion:
This study shows that continuous epidural infusion for postoperative pain was satisfactory in most cases, and that no major side-effects or complications occurred in children nursed on regular wards. The early recognition of unsatisfactory function of an EDA is important for a child's well being.