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Continuous epidural anesthesia after ureteroneocystostomy in children

M P Cain1, D A Husmann, R H McLaren

  • 1Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.

The Journal of Urology
|August 1, 1995
PubMed

Insights

Postoperative epidural anesthesia in pediatric ureteral reimplantation offers effective pain control but increases fever risk and costs. Narcotic use was lower, but catheter complications and higher expenses were noted.

Area of Science:

  • Pediatric Surgery
  • Pain Management
  • Anesthesiology

Background:

  • Ureteral reimplantation is a common pediatric urological procedure.
  • Effective postoperative pain management is crucial for recovery.
  • Epidural anesthesia is an option for managing surgical pain in children.

Purpose of the Study:

  • To compare the efficacy and safety of postoperative epidural anesthesia versus standard analgesics in pediatric patients undergoing ureteral reimplantation.
  • To evaluate the impact on hospital stay, bowel function, narcotic use, fever incidence, catheter complications, and cost.

Main Methods:

  • Retrospective review of 101 pediatric patients with epidural catheters and 50 controls.
  • Data collected included length of hospital stay, time to first bowel activity, narcotic doses, fever incidence, and catheter-related morbidities.
  • Cost analysis comparing epidural anesthesia with standard narcotic regimens.

Main Results:

  • No significant difference in hospital stay or bowel function return between groups.
  • Epidural group had significantly lower narcotic doses (p < 0.05).
  • Increased incidence of postoperative fever (p < 0.05) and 25% catheter-related problems in the epidural group.
  • Epidural management was significantly more costly ($708 vs $14, p < 0.001).

Conclusions:

  • Continuous epidural infusion provides satisfactory pain control after ureteroneocystostomy in children without delaying discharge.
  • This method is associated with increased postoperative fever and higher costs compared to standard pain management.
  • Careful consideration of risks, benefits, and costs is warranted when selecting postoperative pain management strategies.

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