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[Continuous peridural anesthesia in children less than 2 years old]
Insights
Continuous epidural anesthesia using bupivacaine provided effective pain relief for pediatric surgical procedures. This method avoided systemic analgesics during surgery and facilitated a safe, rapid postoperative recovery in children.
Area of Science:
- Pediatric Anesthesiology
- Regional Anesthesia Techniques
- Pain Management in Children
Context:
- Continuous epidural anesthesia is utilized for prolonged pediatric surgical procedures.
- This study investigates the efficacy and safety of continuous lumbar epidural anesthesia in children undergoing various surgeries.
- The use of bupivacaine, with or without adrenaline, was assessed for its hemodynamic effects and analgesic properties.
Purpose:
- To evaluate the effectiveness of continuous epidural anesthesia with bupivacaine in pediatric patients.
- To assess the hemodynamic stability during and after epidural anesthesia in children.
- To determine the duration of analgesia and the need for additional pain management.
Summary:
- Continuous lumbar epidural anesthesia was administered to 23 children undergoing lengthy surgeries, using 0.25% bupivacaine with or without adrenaline.
- Hemodynamic parameters showed a significant decrease in heart rate post-injection, with no significant changes in blood pressure.
- Sufficient analgesia was achieved in most cases, with longer-lasting effects when adrenaline was included, avoiding systemic analgesics during surgery.
Impact:
- Continuous epidural anesthesia with bupivacaine effectively managed pain during complex pediatric surgeries.
- This technique facilitated rapid and safe postoperative recovery, minimizing the need for systemic analgesics.
- The study highlights the safety and efficacy of epidural catheters for both intraoperative anesthesia and postoperative pain control in pediatric patients.
Abstract:
Continuous epidural anaesthesia was carried out in 23 children (age 13.9 +/- 6 months, weight 9.09 +/- 2.5 kg) scheduled for long surgical procedure (soft tissue release for club-foot, "pull-through" for Hirschsprung disease, various genito-urinary procedures). The lumbar epidural space was punctured under general anaesthesia with a 19 G Tuohy needle. A graduated 24 G polyurethane catheter was then inserted and fixed. The local anaesthetic used was bupivacaine 0.25% (0.71 +/- 0.02 ml X kg-1), with or without 1:200,000 adrenaline. Five and 10 min after injection of bupivacaine, heart rate was significantly decreased (p less than 0.05) when compared with pre-induction values, but systolic blood pressure did not change. No other haemodynamic changes occurred. Analgesia was sufficient in all but two cases at incision. Mean duration of surgical procedure was 143 +/- 9.2 min. The time of the first reinjection was significantly longer if bupivacaine with adrenaline was used (116 +/- 2.34 min), when compared with bupivacaine without adrenaline (68.9 +/- 3.92 min) (p less than 0.001). No systemic analgesic was needed during the surgical procedure and anaesthesia was maintained either with halothane (inspiratory fraction less than 0.5%) or enflurane (inspiratory fraction less than 0.8%). All children were extubated at the end of the surgical procedure. The catheter was maintained in 16 children for postoperative analgesia. The first postoperative injection was given 7.1 +/- 0.45 h later. The catheter remained in situ 26.7 +/- 4.1 h. No complication was observed. Thus, during surgery, the need for systemic analgesia was avoided and a rapid and safe postoperative recovery was obtained.(ABSTRACT TRUNCATED AT 250 WORDS)