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Infant lumbar and thoracic epidurals for abdominal surgeries: cases in a paediatric tertiary institution
Sze Ying Thong1, Eliza I-Lin Sin2, Diana Xin Hui Chan1
1Department of Anaesthesia, Singapore General Hospital, Singapore.
Insights
Epidural analgesia is effective for infant abdominal surgery pain relief, with a high success rate when managed actively in specialized settings. This study highlights its safety and efficacy in pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Surgical Care
Background:
- Epidural analgesia is well-established for adult postoperative pain but less so for infants.
- Infant epidural analgesia for abdominal surgery requires specialized management.
- This study retrospectively analyzes its use in a tertiary pediatric institution.
Purpose of the Study:
- To evaluate the efficacy and safety of epidural analgesia in infants undergoing abdominal surgery.
- To assess the management strategies and outcomes of infant epidural analgesia.
- To determine the success rate and complications associated with pediatric epidural catheters.
Main Methods:
- Retrospective review of 54 infants receiving thoracic or lumbar epidurals for abdominal surgery.
- Analysis of patient demographics (mean age 6.1 months, mean weight 6.8 kg) and American Society of Anesthesiologists (ASA) status.
- Inclusion of various abdominal surgeries including gastrointestinal, urogenital, hepatobiliary, and retroperitoneal procedures.
Main Results:
- 96.3% of epidural catheters provided adequate intraoperative analgesia.
- 66.7% provided effective postoperative pain relief.
- Active management (top-ups, infusion adjustments) was needed in 44% of patients postoperatively; technical issues were primary reasons for premature removal.
Conclusions:
- Infant epidural analgesia can achieve high success rates in experienced hands and specialized settings.
- Active management is crucial for optimizing postoperative pain control.
- The procedure appears safe for infants undergoing major abdominal surgeries with minimal major incidents.
Introduction:
There is strong evidence that epidural analgesia provides good postoperative pain relief in adults, but its use in infants is less established. In this retrospective study, we present our experience with managing infant epidural analgesia for abdominal surgeries in a tertiary paediatric institution.
Methods:
The records of 54 infants who had received a thoracic or lumbar epidural as perioperative analgesia for abdominal surgeries were included. The mean age of the infants was 6.1 (standard deviation [SD] 3.8) months and their mean weight was 6.8 kg (SD 1.8). Most (63%) had an ASA (American Society of Anesthesiologists) status of 2 and all underwent elective gastrointestinal, urogenital, hepatobiliary or retroperitoneal surgeries. 20 catheters (37.0%) were inserted in the thoracic region and 33 (61.1%) in the lumbar region.
Results:
A total of 52 (96.3%) catheters provided adequate intraoperative analgesia and 36 (66.7%) provided effective analgesia for the postoperative period. Active management of epidural analgesia, such as through epidural top-ups and infusion rate adjustment, was necessary to optimise analgesia in 22 (44%) of the 50 patients postoperatively. Reasons for premature catheter removal were mainly technical issues such as catheter disconnection, leakage and blockage.
Conclusion:
Our data suggests that in experienced hands, specialised settings and active management, the success rate of epidural analgesia in infants undergoing major abdominal surgeries is high and without major incident.
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