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Continuous extradural anaesthesia in children. Clinical and haemodynamic implications
I Murat1, M M Delleur, C Esteve
1Département d'Anesthésie-Réanimation Chirurgicale, Hôpital Saint-Vincent-de-Paul, Paris, France.
Insights
Continuous extradural anaesthesia in children using bupivacaine with adrenaline provided longer pain relief, especially in younger patients. This technique demonstrated stable hemodynamics in children under 8 years old during surgical procedures.
Area of Science:
- Pediatric Anesthesiology
- Regional Anesthesia
- Pain Management
Background:
- Continuous extradural anesthesia is utilized in pediatric surgery.
- Bupivacaine is a common local anesthetic for pediatric extradural blocks.
- The role of adrenaline in bupivacaine extradural anesthesia in children requires further investigation.
Purpose of the Study:
- To report the experience with continuous extradural anesthesia in 229 children.
- To evaluate the efficacy and safety of bupivacaine with and without adrenaline for pediatric extradural anesthesia.
- To assess the hemodynamic effects of extradural anesthesia in different pediatric age groups.
Main Methods:
- A retrospective review of 234 continuous extradural anesthetics in children aged 0-2, 2-8, and older than 8 years.
- Administration of 0.25% bupivacaine with or without adrenaline (1:200,000).
- Monitoring of hemodynamic parameters (heart rate, systolic arterial pressure) in a subset of 74 children.
Main Results:
- Bupivacaine with adrenaline resulted in significantly longer durations of analgesia (92 min) compared to bupivacaine alone (71 min) (P < 0.001).
- Younger children (<8 years) showed minimal hemodynamic changes (heart rate, systolic arterial pressure) with extradural anesthesia and adrenaline.
- Older children (>8 years) experienced a significant decrease in heart rate and systolic arterial pressure.
Conclusions:
- Continuous extradural anesthesia with bupivacaine and adrenaline is effective for prolonged analgesia in children.
- The addition of adrenaline to bupivacaine extradural anesthesia appears to be safe and beneficial for younger pediatric patients.
- This technique offers a viable option for intraoperative and postoperative pain management in pediatric surgery.
Abstract:
This study reports the experience of a department of paediatric anaesthesia with 234 continuous extradural anaesthetics performed in 229 children over a 15-month period. Fifty-nine of the children were aged 0-2 yr, 71 were aged 2-8 yr and 104 were older than 8 yr. The surgical procedures lasted more than 60 min (mean 150 +/- 10.6 min); all were carried out under light general anaesthesia. Technical procedure and difficulties are reported. The only local anaesthetic agent used was bupivacaine with or without adrenaline. Mean initial dosage was 0.75 ml kg-1 for children weighing less than 20 kg and 1 ml/10 cm of height for children taller than 100 cm. Using 0.25% bupivacaine mean times until a further injection were 92.0 +/- 2.0 min for bupivacaine with adrenaline and 71.0 +/- 2.5 min for bupivacaine without adrenaline (P less than 0.001). A much longer duration of analgesia was found for younger children using the solution with adrenaline. A haemodynamic study was performed in 74 unpremedicated children (ASA I; aged 0-2 yr (n = 15), 2-8 yr (n = 26) and older than 8 yr (n = 35). Before induction of anaesthesia, heart rate (HR) was significantly increased in the youngest children, but no significant change was found for systolic arterial pressure (SAP). After extradural anaesthesia with 0.25% bupivacaine with adrenaline 1:200000, minimal changes in HR or SAP occurred in children younger than 8 yr; in those older than 8 yr a significant decrease in both HR and SAP was observed. Changes in SAP were at their maximum 25 min after the extradural block and changes in HR were not statistically significant before the 25th min following injection of local anaesthetic. The catheter remained in place in 155 children for postoperative analgesia, mainly for the first 48 h.