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Patient-controlled epidural analgesia in children: can they do it?
William J Greeley1, Patrick K Birmingham, Melissa Wheeler
1Departments of *Anesthesiology, †Nursing, and ‡Pediatrics, Children's Memorial Hospital at Northwestern University Medical School, Chicago, Illinois.
Insights
Patient-controlled epidural analgesia (PCEA) effectively manages pediatric postoperative pain. This technique is safe and well-tolerated in children as young as 5 years old.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Regional Anesthesia
Background:
- Patient-controlled epidural analgesia (PCEA) is underutilized in pediatric postoperative pain management.
- Limited data exists on children's ability to use PCEA and its efficacy.
Purpose of the Study:
- To analyze the efficacy and safety of PCEA for acute postoperative pain control in children.
- To assess children's cognitive ability and willingness to use PCEA.
Main Methods:
- Descriptive analysis of prospectively recorded data from 132 PCEA procedures in 128 children.
- Monitoring for analgesia quality, toxicity, and adverse effects.
Main Results:
- Satisfactory analgesia achieved in 90.1% of patients for up to 103 hours.
- No desaturation events or clinical toxicity observed.
- Children aged 5 years demonstrated cognitive ability and willingness to use PCEA.
Conclusions:
- PCEA provides effective and safe postoperative pain relief in children.
- Children as young as 5 can successfully utilize PCEA.
- PCEA should be considered a valuable strategy in pediatric pain management.
Unlabelled:
Extensive clinical experience and many studies support the use of i.v. patient-controlled analgesia (i.v. PCA) and regional anesthesia techniques for the treatment of postoperative pain in children. In contrast, little has been reported about the ability of children to use patient-controlled epidural analgesia (PCEA) or about the efficacy of this technique. We report a descriptive analysis of prospectively recorded data in 128 children (132 procedures) in whom PCEA was used for acute postoperative pain control. Satisfactory analgesia was obtained in 119 patients (90.1%) for up to 103 h with no episodes of desaturation and without clinical evidence of toxicity or serious adverse effects. Analgesia was satisfactory with the initial settings in 89 patients; in 38 others, this was achieved with changes in PCEA settings or solution. Five patients were switched to i.v. PCA because of inadequate analgesia. Eight patients with satisfactory analgesia were converted to i.v. PCA because of adverse effects. Children as young as 5 yr had the cognitive ability to understand and the willingness to use PCEA, consistent with reported use of i.v. PCA. Careful attention should be paid to the total hourly local anesthetic dose to avoid exceeding the recommended limits. Our prospectively collected data demonstrate that PCEA provides satisfactory analgesia with a small incidence of adverse side effects in children and should be considered along with other strategies in pediatric postoperative pain management.
Implications:
A descriptive analysis of prospectively recorded data in 132 children receiving patient-controlled epidural analgesia for postoperative pain relief demonstrates satisfactory analgesia without serious toxicity or side effects in children as young as 5 yr. This modality should be considered as another strategy in pediatric postoperative pain management.