Epidural analgesia in children with cerebral palsy.
OBJECTIVE
Two modalities of epidural analgesia in children with two types of cerebral palsy (CP) were compared for differences in the incidence of common complications (inadequate analgesia, hypopnea, hypoxaemia, sedation, vomiting, pruritus, urinary retention, and seizures).


METHODS
Demographic, procedural and postoperative complication data were collected on children with CP receiving epidural analgesia. Information was recorded contemporaneously with the child's care by one of the authors on 92 consecutive children with CP (age, 107 +/- 50.1 mo; weight, 26 +/- 14.2 kg) who had undergone infra-umbilical orthopaedic or Nissen fundoplication procedures between December 1994 and December 1996. The first 44 patients received intermittent bolus (IB) epidural morphine and the next 48 received continuous infusion (CI) bupivacaine and fentanyl. Two forms of CP (spastic diplegia and quadriplegia) and the two modalities of analgesia were compared.


RESULTS
Excellent analgesia was obtained in 91/92 patients. Excessive sedation occurred in six patients (6.5%) but only in IB patients, (P < 0.02 vs CI). Emesis occurred in 52% of patients, and was more common in diplegic than in quadriplegic patients (68% vs 38%, P < 0.01). Pruritus was observed in 29% of patients and was more common in diplegia than quadriplegia (48% vs 12.5%, P < 0.001). The incidences of hypopnea, hypoxaemia, urinary retention and seizures were not affected by the types of CP or analgesia and no difference in sedation was observed between spastic diplegic and quadriplegic patients.


CONCLUSIONS
Continuous infusion of epidural bupivacaine and fentanyl provided excellent analgesia for children with CP without serious complications. Intermittent bolus epidural morphine was associated with a high incidence of excessive sedation and should be avoided in this population.
Department of Anesthesiology, Alfred I. duPont Hospital for Children, Wilmington, DE 19899, USA. brbrenn@nemours.org
B R
BR
Brenn
R P
RP
Brislin
J B
JB
Rose
D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000627:therapeutic use; D002045:Bupivacaine / Q000627:therapeutic use; D002547:Cerebral Palsy / Q000145:classification / Q000601:surgery*; D002648:Child; D003243:Consciousness / Q000187:drug effects; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D018662:Fundoplication; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D015994:Incidence; D007262:Infusions, Intravenous; D008297:Male; D009020:Morphine / Q000009:adverse effects / Q000627:therapeutic use*; D019637:Orthopedic Procedures; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced; D011446:Prospective Studies; D011537:Pruritus / Q000139:chemically induced; D011782:Quadriplegia / Q000601:surgery; D012120:Respiration Disorders / Q000209:etiology; D012640:Seizures / Q000139:chemically induced; D016055:Urinary Retention / Q000139:chemically induced
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D005283:Fentanyl; D002045:Bupivacaine