title: Continuous epidural anesthesia after ureteroneocystostomy in children.
abstract: We retrospectively reviewed the records of 101 pediatric patients who underwent uncomplicated ureteral reimplantation and were treated with postoperative epidural catheters for pain management. A total of 50 pediatric patients treated without epidural anesthesia was used as the control group. Length of hospital stay, time to first bowel activity, doses of narcotics, incidence of postoperative fever and evidence of epidural catheter related morbidities were documented. The costs of postoperative epidural anesthesia versus standard analgesics were compared. There was no significant difference in length of hospital stay or return of bowel function between treatment groups. Total doses of narcotics given during the hospital stay were significantly less for the epidural group (p < 0.05). The children given epidural anesthesia also had a significant increase in the incidence of postoperative fever (p < 0.05) and 25% had catheter related problems that often resulted in early removal of the epidural catheter. The cost of pain management using an epidural catheter was significantly greater than that of the standard narcotic regimen ($708 versus $14, p < 0.001). Continuous epidural infusion provides satisfactory pain control after ureteroneocystostomy in children without delaying hospital discharge. This technique of pain management is associated with a significant increase in the incidence of postoperative fever and overall cost compared to standard methods of postoperative pain management.
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: M P
authors.initials: MP
authors.lastname: Cain
authors.forename: D A
authors.initials: DA
authors.lastname: Husmann
authors.forename: R H
authors.initials: RH
authors.lastname: McLaren
authors.forename: S A
authors.initials: SA
authors.lastname: Kramer
mesh_terms: D000293:Adolescent; D000767:Anesthesia, Epidural / Q000191:economics / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D014513:Ureter / Q000637:transplantation*; D001743:Urinary Bladder / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000601:surgery*