Continuous extradural anaesthesia in children. Clinical and haemodynamic implications.

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.