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[Peridural catheter for postoperative long-term analgesia in children]
K Boos1, T Beushausen, W Ohrdorf
1Abt. Anästhesie und Intensivmedizin, Kinderkrankenhaus auf der Bult, Hannover.
Insights
Continuous epidural anesthesia provides effective postoperative pain relief and sympathicolysis in pediatric patients. Subcutaneous tunneling of caudal epidural catheters is recommended to minimize bacterial colonization and ensure patient safety.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Regional Anesthesia
Context:
- Continuous epidural anesthesia is established in adults but less reported in pediatric patients.
- Postoperative analgesia and sympathicolysis are critical in pediatric care.
- Limited data exists on the safety and efficacy of epidural techniques in infants and children.
Purpose:
- To evaluate the efficacy and safety of continuous epidural anesthesia in pediatric patients.
- To assess the incidence of bacterial colonization in epidural catheters.
- To determine optimal catheter placement and tunneling techniques for pediatric epidural anesthesia.
Summary:
- This study assessed 77 continuous epidural catheters in 65 pediatric patients (4 weeks to 19 years) for postoperative analgesia.
- Bupivacaine 0.125% was the primary anesthetic, with optional morphine or clonidine.
- Bacteriological examination of 64 catheters revealed colonization in 15, with significantly fewer in subcutaneously tunneled caudal catheters (p < 0.05), though no infections occurred.
Impact:
- Continuous epidural anesthesia is effective and safe for pediatric postoperative pain management and sympathicolysis.
- Subcutaneous tunneling of caudal epidural catheters reduces bacterial colonization risk.
- Findings support the broader application of epidural techniques in pediatric anesthesia.
Introduction:
Continuous epidural anaesthesia is a well established procedure for postoperative analgesia as well as sympathicolysis in adult patients. It is, however, much less frequently reported in infants and children.
Materials And Methods:
From October 1991 to November 1994 65 infants, children and adolescents aged 4 weeks to 19 years, body weight 3.9 kg to 79 kg, received 77 epidural catheters for postoperative analgesia. 54 catheters were inserted via the caudal approach either with (n = 19) or without (n = 35) subcutaneous tunnelling. 23 catheters were placed via a low midline lumbar epidural puncture either through interspace L5/S1 or L4/L5. The local anaesthetic of choice in this study was bupivacaine 0.125% without adrenaline infused continuously via a constant-flow infusion pump. 20 patients received additional boluses of morphine and in 3 patients clonidine was added. The catheters were left in place for an average of 84.5 h. After removal the catheter-tip was submitted for bacteriological examination. The results of 64 specimens were available.
Results:
For satisfactory analgesia an average of 0.18 mg x kg-1 x h-1 bupivacaine 0.125% had to be administered via the lumbar route, while the mean dose for caudal catheters was 0.3 mg x kg-1 x h-1. Intestinal peristalsis re-occurred within 33 h after surgery. The first stool was passed within 48 h. Of the 64 catheters which were microbiologically examined, 15 exhibited bacterial colonisation with a statistically significant difference between those subcutaneously tunnelled and those inserted directly (p < 0.05). There were, however, no signs of local or systemic infection.
Conclusions:
The results of continuous epidural anaesthesia and sympathicolysis in infants and children are encouraging. This technique is readily employable and complications seem to be rare. Satisfactory analgesia and sympathicolysis were achieved. Based on the results of our bacteriological studies we recommend that caudal catheters are tunnelled subcutaneously in cranio-lateral direction.