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Thoracic epidural anaesthesia in infants and children
1Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee.
Insights
Thoracic epidural anesthesia offers safe and effective postoperative pain relief in children undergoing thoracic surgery. This method demonstrated no serious complications, with only minor side effects like itching reported.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Thoracic Surgery
Background:
- Epidural anesthesia provides superior analgesia and improves postoperative patient status.
- While caudal and lumbar epidural techniques are established in children, thoracic epidural anesthesia data is limited.
Purpose of the Study:
- To evaluate the safety and efficacy of thoracic epidural anesthesia for postoperative pain management in pediatric patients.
Main Methods:
- Retrospective review of 63 children (3 months to 18 years) who received thoracic epidural anesthesia.
- Catheters placed at the thoracic level, with analgesia via bupivacaine/fentanyl infusion and boluses.
Main Results:
- Successful thoracic epidural catheter placement in all patients.
- No inadvertent dural punctures or respiratory depression related to the anesthesia.
- Minor adverse effects (pruritus) in 6 patients, with 3 requiring treatment.
Conclusions:
- Thoracic epidural anesthesia is a safe and effective method for postoperative analgesia in children after thoracic surgery.
Abstract:
When compared with conventional analgesic techniques, epidural anaesthesia not only provides improved analgesia, but also has several beneficial effects on the postoperative respiratory, cardiovascular, and metabolic status of the patient. Although the efficacy and safety of caudal and lumbar epidural anaesthesia in children has been demonstrated, there is little information concerning the use of thoracic epidural anaesthesia. The purpose of our review was to evaluate the safety of thoracic epidural anaesthesia in infants and children. We retrospectively reviewed our three-year experience with thoracic epidural anaesthesia for postoperative analgesia in children. Epidural catheters were placed at the thoracic level without difficulty in 63 children ranging in age from three months to 18 yr and in weight from 3.2 to 78 kg. Postoperative analgesia was provided by the continuous infusion of a bupivacaine/fentanyl mixture, supplemented with intermittent epidural fentanyl by bolus as needed. Epidural catheters were successfully placed in all patients. No inadvertent dural punctures were noted. No episodes of respiratory depression related to epidural analgesia occurred. Minor adverse effects including pruritus occurred in six patients, three of whom required pharmacological intervention with diphenhydramine. Our review suggests that this is a safe and effective method of postoperative analgesia following thoracic surgery in children.