[Peridural catheter for postoperative long-term analgesia in children].
BACKGROUND
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.


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.
Boos
K
K
Abt. Anästhesie und Intensivmedizin, Kinderkrankenhaus auf der Bult, Hannover.
Beushausen
T
T
Ohrdorf
W
W
D000293:Adolescent; D000328:Adult; D015360:Analgesia, Epidural / Q000295:instrumentation*; D002045:Bupivacaine / Q000008:administration & dosage; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*
D002045:Bupivacaine
Periduralkatheter zur postoperativen Daueranalgesie bei Kindern.