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Comparison of spinal anaesthesia with epidural anaesthesia in paediatric surgery
1Department of Anaesthesiology, Kuopio University Hospital, Finland.
Insights
Spinal anaesthesia (SA) is more effective than epidural anaesthesia (EA) for paediatric surgery, requiring less supplemental anesthesia. While EA offers longer pain relief, SA is preferred for its overall efficacy in minor pediatric operations.
Area of Science:
- Pediatric Anesthesiology
- Surgical Pain Management
Background:
- Regional anesthesia is a common technique for pediatric surgery.
- Spinal anesthesia (SA) and epidural anesthesia (EA) are two primary regional techniques used in pediatric patients.
- Choosing the optimal technique is crucial for efficacy and patient safety.
Purpose of the Study:
- To compare the efficacy and safety of spinal anesthesia (SA) versus epidural anesthesia (EA) in children undergoing elective lower abdominal surgery.
- To evaluate postoperative pain relief and side effect profiles of both anesthetic techniques.
Main Methods:
- A randomized controlled trial involving 202 children (2 months to 17 years) undergoing elective infraumbilical surgery.
- Children were randomly assigned to receive either SA or EA.
- Efficacy was assessed by the need for supplemental anesthesia, and outcomes included hemodynamic stability, pain relief, and postoperative side effects.
Main Results:
- SA was more efficacious, with 8% of patients requiring supplemental general anesthesia compared to 30% in the EA group (24% general anesthesia, 6% fentanyl).
- Hemodynamic stability was better maintained with EA, while SA required interventions for heart rate/blood pressure in 6 patients.
- EA provided longer pain relief in the recovery room; however, postoperative side effect incidence was similar, with positional headache (PDPH) noted in both groups, predominantly in older children with SA and younger children with accidental dural puncture during EA.
Conclusions:
- Spinal anesthesia (SA) is highly effective for minor pediatric operations.
- SA is preferred for its efficacy, despite requiring interventions for hemodynamic stability in some cases.
- Both SA and EA demonstrate low incidences of postoperative side effects, with PDPH being the most notable, occurring in specific age groups and circumstances.
Abstract:
202 children aged 2 months to 17 years, undergoing elective paediatric operations below the umbilicus, were allocated randomly to receive either spinal (SA) or epidural anaesthesia (EA). SA was more efficacious since 8 children of 102 needed supplementation with general anaesthesia, in contrast to EA where 24 children of 100 were supplemented with general anaesthesia and 6 with fentanyl. The haemodynamic stability was maintained during EA, whereas during SA 6 patients were given medication to increase heart rate/blood pressure. EA provided longer pain relief than SA in the recovery room. The incidence of postoperative side effects was similarly low following SA and EA. Complaints after discharge were also similar. General weakness (7% vs 8% after SA and EA, respectively), low back pain (6% vs 6%), headache (7% vs 4%), fever (6% vs 4%) and positional headache (PDPH) (5% vs 3%) were the most frequent side effects. PDPH was only observed following SA in children aged 11 years or older. Following EA, PDPH was also observed in the younger age group after accidental dural puncture. In conclusion, we prefer SA for minor paediatric operations due to its high efficacy.