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Complications of continuous epidural infusions for postoperative analgesia in children
C E Wood1, G V Goresky, K A Klassen
1Department of Anaesthesia, Alberta Children's Hospital, University of Calgary.
Insights
Epidural analgesia in children is generally safe, with most complications being minor and easily managed. This study reviewed 190 pediatric cases, finding common side effects like nausea and motor blockade.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacology
Background:
- Epidural analgesia is utilized for pediatric postoperative pain management.
- Assessing the safety profile of epidural analgesia in pediatric patients is crucial.
Observation:
- A retrospective review of 190 pediatric patients receiving continuous epidural analgesia over two years.
- Data collected on management, side effects, and complications requiring medical intervention.
Findings:
- The most frequent complications included nausea and vomiting (23%), motor blockade (15.8%), over-sedation (6.3%), and pruritus (5.2%).
- Four cases showed potential bupivacaine toxicity or resistance, with measured serum levels.
- Early epidural discontinuation occurred in 41 patients, primarily due to technical catheter issues.
Implications:
- Most epidural-related complications in children are minor and manageable.
- Continuous epidural analgesia can be a safe option for pediatric postoperative pain when monitored.
- Further research into bupivacaine toxicity in pediatric epidural use may be warranted.
Abstract:
To determine the incidences of side effects and complications associated with the use of epidural analgesia for infants and children at the Alberta Children's Hospital, we reviewed our experience over a two-year period. A database was established for recording management, side effects and complications of each epidural, and this is a retrospective review of that database. Problems were identified as complications if there was a need for medical intervention related to the patient complaint, and if the intervention was documented in the patient record. Continuous epidural analgesia with bupivacaine 0.125% or bupivacaine 0.1% with epinephrine was used for managing postoperative pain in 190 children with mean age 5.6 yr (range 1 mo to 18 yr) and the mean weight 22 kg (range 4-88 kg). Mean duration of the epidural infusions was 4.7 days (range 1-16 d). In 127 patients, 203 complications were recorded. Complications, in order of frequency, were nausea and vomiting (23% of patients), motor blockade (15.8% of patients), over-sedation (6.3% of patients), and pruritus (5.2% of patients). Four patients had complications which were potentially related to toxic effects of, or resistance to, bupivacaine, and serum levels of bupivacaine were measured at 3.86, 5.5, 2.1 and 2.34 micrograms.ml(-1). Early discontinuation of the epidural occurred in 41 cases, technical problems with the epidural catheter being the commonest reason (21 cases). Although three potentially serious complications were identified (one catheter site infection, one seizure, one respiratory depression) none was associated with lasting consequences. The majority of complications associated with the use of epidurals were minor and easily remedied.(ABSTRACT TRUNCATED AT 250 WORDS)