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Analgesia and ventilatory response to CO2 following epidural sufentanil in children
M Benlabed1, C Ecoffey, J C Levron
1Département d'Anesthésiologie, Hôpital Bicêtre, Kremlin Bicêtre, France.
Insights
Epidural sufentanil provided effective pain relief after pediatric urologic surgery, with significant analgesia and minimal respiratory impact. While it caused some side effects like drowsiness, it did not lead to apnea or further respiratory depression.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pain Management
Background:
- Postoperative pain management in children is crucial for recovery.
- Epidural analgesia offers targeted pain relief.
- Sufentanil is a potent opioid used for anesthesia and analgesia.
Purpose of the Study:
- To evaluate the efficacy and safety of epidural sufentanil for pain control in children undergoing urologic surgery.
- To assess the impact of epidural sufentanil on respiratory function and periosteal analgesia.
Main Methods:
- A study involving 15 children (4-12 years) receiving epidural sufentanil (0.75 microgram/kg) post-urologic surgery.
- Assessment of analgesia onset and duration.
- Monitoring for side effects, including respiratory parameters and periosteal pain response in a subset of eight children.
Main Results:
- Analgesia onset was 3.0 ± 0.3 min, duration 198 ± 19 min.
- Significant periosteal analgesia observed in tibia and radius.
- Minor side effects: pruritus (3/15), nausea/vomiting (5/15), drowsiness (10/15). No apnea.
- Ventilatory response to CO2 decreased significantly postoperatively and after sufentanil administration.
Conclusions:
- Epidural sufentanil provides effective analgesia after pediatric urologic surgery.
- The drug demonstrates a favorable safety profile regarding respiratory depression.
- Further investigation into the ventilatory response to CO2 is warranted.
Abstract:
The authors studied the effects of epidural sufentanil (0.75 microgram.kg-1) after urologic surgery in 15 children ranging in age from 4 to 12 yr, and in weight from 14 to 47 kg. The onset and duration of analgesia were 3.0 +/- 0.3 and 198 +/- 19 min, respectively (mean +/- SEM). Side effects included pruritus (3/15), nausea and vomiting (5/15), drowsiness (10/15), and urinary retention (1/11). No apnea was observed. Periosteal analgesia and ventilation were studied in eight of the children (mean age 8.6 +/- 0.8 yr). There was significant periosteal analgesia of the tibia (30, 60, 90, and 120 min after injection) and of the radius (60, 90, and 120 min after injection). Resting respiratory rate and tidal volume did not change during the study. Resting minute-ventilation decreased from 6.3 +/- 0.5 l.min-1 preoperatively to 5.6 +/- 0.6 l.min-1 (P less than 0.05) postoperatively, before epidural sufentanil injection; it did not decrease further after epidural sufentanil. Similarly, end-tidal CO2 tension increased significantly from 37.2 +/- 0.7 mmHg preoperatively to 39.9 +/- 1.2 mmHg (P less than 0.05) postoperatively, before epidural sufentanil; epidural sufentanil did not cause a further significant increase in end-tidal CO2 tension. The slope of the CO2 ventilatory response curve decreased significantly from 1.68 +/- 0.12 l.min-1. mmHg-1 preoperatively to 1.10 +/- 0.13 l.min-1.mmHg-1 (P less than 0.01) postoperatively. There were further significant decreases to 0.68 +/- 0.10 and 0.89 +/- 0.16 l.min-1.mmHg-1 30 and 60 min after epidural sufentanil.(ABSTRACT TRUNCATED AT 250 WORDS)