title: Comparison of epidural pain treatment with sufentanil-ropivacaine infusion with and without epinephrine in children.
abstract: BACKGROUND
  Epidural analgesia provides outstanding pain relief after surgery, but it is also associated with numerous adverse effects. In order to improve postoperative pain management in children we determined whether the use of epinephrine added to epidural sufentanil-ropivacaine infusion reduced drug requirements, the intensity and duration of postoperative pain and the incidence and severity of adverse effects.
  
  
  METHODS
  A prospective, randomized, double blind, parallel group study design was used in 61 children. The children were given continuous epidural sufentanil-ropivacaine infusion either with (n=32) or without (n=29) epinephrine for postoperative analgesia. Intravenous ketoprofen, a non-steroid anti-inflammatory drug, was used for all children, and epidural ropivacaine was used for rescue analgesia. The drug consumption, intensity of pain at rest and during activity, and all adverse effects were recorded.
  
  
  RESULTS
  : The need for sufentanil (P=0.001) and ropivacaine (P=0.006) was significantly lower in the with-epinephrine group than in the without-epinephrine group. The mean duration of epidural infusion (62 h) was similar in both groups. Four children in the without-epinephrine group were noticed to have a low oxygen saturation (SpO2<90%), and in one child a low respiratory rate (8 breaths min-1). The incidence of pruritus was higher in the without-epinephrine group (P=0.026).
  
  
  CONCLUSIONS
  Both infusions provided effective pain relief, and epinephrine as an adjuvant to continuous epidural sufentanil-ropivacaine infusion seems to be useful in children.
authors.affiliation: Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland. hannu.kokki@nam.fi
authors.forename: Hannu
authors.initials: H
authors.lastname: Kokki
authors.forename: A
authors.initials: A
authors.lastname: Ruuskanen
authors.forename: M
authors.initials: M
authors.lastname: Karvinen
mesh_terms: D000293:Adolescent; D000322:Adrenergic Agonists / Q000627:therapeutic use*; D000577:Amides / Q000008:administration & dosage* / Q000627:therapeutic use*; D015360:Analgesia, Epidural / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D010146:Pain / Q000188:drug therapy*; D011182:Postoperative Care; D011446:Prospective Studies; D000077212:Ropivacaine; D017409:Sufentanil / Q000008:administration & dosage* / Q000627:therapeutic use*
chemical_list: D000322:Adrenergic Agonists; D000577:Amides; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D000077212:Ropivacaine; D017409:Sufentanil; D004837:Epinephrine