Pediatric analgesia with epidural fentanyl citrate administered by nursing staff

Even though epidural analgesia is effective and has advantages over conventional postoperative analgesia, it is also labor intensive, requiring 24-hour supervision by an anesthesiologist. In an effort to decrease the manpower requirements, some hospitals allow the nursing staff to administer epidural narcotics to adult patients. In children, however, this practice has been limited. We retrospectively reviewed our experience over 12 months with this procedure. Epidural catheters (caudal, lumbar, or thoracic) were placed in 43 pediatric patients for acute and chronic pain management. All patients received a continuous epidural infusion of bupivacaine hydrochloride with fentanyl citrate. Eleven (26%) of the 43 patients required supplemental analgesia and were given 45 doses of epidural fentanyl. Adequate analgesia was achieved in all patients. No intravascular or intrathecal injections were noted, nor did any inadvertent epidural injections of medications occur. No patient had respiratory depression (respiratory rate less than 10% for age). We believe epidural administration of fentanyl by a carefully educated nursing staff is safe and effective in children.