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[Epidural analgesia for postoperative pain in infants and children]
R Efrat1, A Oppenheim, Y Weiss
1Dept. of Pediatric Anesthesia, Schneider Children's Medical Center, Hadassah Medical School, Jerusalem.
Insights
Babies and children experience significant postoperative pain, contrary to previous beliefs. Continuous epidural analgesia is a safe and effective method for managing severe pain in infants undergoing major surgery.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Neonatal Surgery
Background:
- Historically, underestimation of pediatric postoperative pain led to inadequate pain management in infants.
- Recent evidence indicates that neonates and children experience pain and its physiological consequences, similar to adults.
- Preventing the stress response to untreated pain has shown to improve outcomes in infants post-cardiac surgery.
Observation:
- Regional analgesia techniques, including caudal analgesia and nerve blocks, are standard for postoperative pain control in children.
- Epidural and spinal anesthesia are increasingly utilized for pain management in infants and young children.
- The authors present 3 cases of continuous epidural analgesia in infants, highlighting its application in major thoracic, abdominal, pelvic, and lower limb surgeries.
Findings:
- Continuous epidural analgesia was successfully used in infants for postoperative pain management lasting over 24 hours.
- No major complications or inadvertent dural punctures were observed in the treated cases.
- Judicious monitoring of respiratory function is crucial for infants receiving epidural narcotics.
Implications:
- Continuous epidural analgesia offers a viable and safe option for managing severe postoperative pain in infants.
- This approach can mitigate the physiological stress response associated with untreated pain, potentially improving recovery.
- Further research and clinical application of regional anesthesia techniques are warranted for optimizing pediatric postoperative care.
Abstract:
Until recently it was thought that children do not suffer as much from postoperative pain as adults. Coupled with the fear of administering systemic opiates to young children, this meant that babies were often left "to cry it out." Lately it has been acknowledged that children and even babies not only feel pain, but similar to adults, suffer from the physiologic consequences of the untreated stress response. It has also been shown that preventing this response improves the postoperative period in babies after undergoing cardiac surgery. Regional analgesia is commonly used to provide postoperative pain control in adults and children. Following minor lower abdominal surgery, pain relief is often provided by caudal analgesia or specific nerve blocks. Epidural and spinal anesthesia are also gaining popularity for young children and even babies. We describe 3 cases of continuous epidural analgesia in babies, and review other methods for postoperative pain relief. These cases are representative of the many which we have treated over the past 2 years. We use epidural analgesia in children who undergo major thoracic, abdominal, pelvic and major lower limb surgery, and are expected to suffer significant postoperative pain for more than 24 hours. We have not encountered any major complications or inadvertent dural punctures. We judiciously monitor these children, especially their respiratory function, as long as they receive epidural narcotics.