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[Epidural anesthesia in pediatrics. Apropos of 30 cases]
G Clément1, F Arbez-Gindre, F Lassauge
1Service d'anesthésie-réanimation, Centre hospitalier régional et universitaire, Besançon.
Insights
Continuous epidural anesthesia provided safe and effective pain relief for pediatric surgical patients. This technique facilitated post-operative management, demonstrating its value in pediatric anesthesia.
Area of Science:
- Pediatric Anesthesiology
- Regional Anesthesia Techniques
- Pain Management in Children
Context:
- Long surgical procedures in children require effective anesthesia and analgesia.
- Continuous epidural anesthesia is a potential option for managing pediatric surgical pain.
- Assessing the efficacy and safety of epidural anesthesia in pediatric patients is crucial.
Purpose:
- To evaluate the effectiveness and safety of continuous epidural anesthesia in pediatric patients undergoing major surgery.
- To determine the success rate of sensory blockade and muscle paralysis.
- To identify any complications associated with the procedure.
Summary:
- Continuous epidural anesthesia was administered to 30 children (2 months to 15 years) for thoracic, abdominal, or urologic procedures.
- Lidocaine and/or bupivacaine were used, with bupivacaine avoided in infants under 6 months.
- Complete sensory blockade was achieved in 26 patients, with some limitations in muscle paralysis noted in specific cases.
- Complications included dural penetration and hemodynamic instability, but overall, the technique provided effective post-operative analgesia for 24-48 hours.
Impact:
- Continuous epidural anesthesia offers a safe and effective method for managing post-operative pain in pediatric surgical patients.
- This technique simplifies patient management during the post-operative period.
- Further research may optimize anesthetic choices and techniques for specific pediatric surgical populations.
Abstract:
Continuous epidural anesthesia was carried out in 30 children aged from 2 months to 15 years (12 are less than 5 years old) and scheduled for long surgical procedure (thoracic, abdominal or urologic procedures). The epidural space was punctured under general anesthesia on a midline approach with a saline filled syringe. The catheter is easily inserted and fixed. 28 are inserted before surgery; 2 at the end of procedure. The local anesthesia used was lidocaine 1% (with 1/200,000 epinephrine) and/or bupivacaine 0.5 alone or mixed; bupivacaine wasn't used for children aged less than 6 months. During surgery, complete sensory blockade was obtained in 26 cases; insufficient analgesia or lateralization of the block in the 2 other cases. Complete muscle paralysis, researched for 17 children, was altered for 11 patients. The insufficient was observed in upper abdominal surgery for which etidocaine was used unless the patient is aged less than 6 months (in this case lidocaine 2% was preferred). As complications, a dural penetration was observed in a child aged 2 months, and an hemodynamic instability for another patient for which 100 ml albumin was used. In the post operative period, the catheter remained in situ from 24 to 48 hours, provide safe and effective analgesia and therefore eased the management of the children.