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Introduction of continuous regional techniques for postoperative paediatrics patients: one years' experience from two
R Holland1, B Anderson, T Watson
1Paediatric Intensive Care, Children's Health South Pacific, Auckland.
Insights
Continuous regional analgesia techniques like epidural and interpleural are effective for pediatric pain management. However, experienced staff are crucial to mitigate potential complications in children and neonates.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Regional Anesthesia
Background:
- Continuous regional analgesic techniques are utilized for postoperative pain control in pediatric patients.
- Standardized protocols were implemented in two hospitals for postoperative care units.
Purpose of the Study:
- To evaluate the utilization, safety, and efficacy of continuous regional analgesic techniques in neonates and children.
- To identify and analyze complications associated with these techniques in a pediatric population.
Main Methods:
- Retrospective review of 80 pediatric patients who received continuous regional analgesic techniques in 1992.
- Analysis of records for epidural and interpleural analgesia, including patient demographics and complications.
- Patients were managed in high-dependency nursing areas.
Main Results:
- Epidural analgesia was used in 68 children (13 neonates); 9% experienced major complications (e.g., block failure, subarachnoid puncture, respiratory depression, foot-drop).
- Interpleural analgesia was used in 12 patients, with one neonate experiencing a convulsion.
- Minor complications included catheter leaks, nausea, vomiting, and pruritus.
Conclusions:
- Continuous regional techniques demonstrate effectiveness in pediatric pain management.
- Potential complications necessitate careful monitoring and experienced personnel for safe administration.
- Specialized training is essential for healthcare providers performing and managing these blocks in children.
Aim:
To review the use, safety and efficacy of continuous regional techniques in children and neonates.
Methods:
The records of all children who received postoperative continuous regional analgesic techniques during the year 1992 at the Starship Children's Hospital and Waikato Base Hospital were reviewed. In both post operative care units orders, procedures and protocols were standardised.
Results:
A total of 80 children received these techniques. Patients were cared for in high dependency nursing areas. The two techniques used were epidural and interpleural analgesia. Epidural: The majority (68) had epidural catheters and of these 13 infants were in their first month of life. Major problems occurred in six (9%) of children receiving epidurals--two blocks failed completely, two suffered subarachnoid puncture, one had respiratory depression and one developed a foot-drop. The blockade failure and subarachnoid punctures occurred early in the establishment of paediatric epidural analgesic services. Minor problems included the necessity for morphine supplementation in three (4%) children, leaks about the catheter in seven (10%), nausea and vomiting in six (9%), two (3%) developed pruritus and one block was ceased because of concerns expressed about masking symptoms of compartmental compression. Interpleural: twelve patients were treated with this technique. One neonate suffered a convulsion.
Conclusion:
Major continuous regional techniques in paediatric patients are effective, but because of potential complications, there is a requirement that these blocks be performed, monitored and cared for by staff experienced and trained with these procedures.