Retrospective evaluation of continuous epidural infusion for postoperative pain in children.
BACKGROUND
The safety and efficacy of postoperative epidural analgesia (EDA) in children are not well documented in larger series of patients given routine postoperative care. The aims of this study were to evaluate the efficacy of pain relief, determine the incidence and type of complications during the entire period of epidural pain treatment in children, and assess the factors affecting efficacy


METHODS
Children treated postoperatively with an EDA infusion during the period 18 September 1994 to 1 January 1999 were studied. Data regarding the age, gender, efficacy of analgesia, duration of epidural infusion, types of side-effects and complications, reasons for discontinuation, and types and duration of surgery were collected daily by the Acute Pain Treatment Service. The sensory dermatomal level of the surgical incision site was included retrospectively.


RESULTS
Five hundred and eighteen epidural infusions were given to 476 children. Pain relief was rated as 'good' at 76% of visits. There were no major complications or sequelae. Thirty-seven per cent of the epidural infusions were prematurely discontinued, and 21% were discontinued because of unsatisfactory analgesia. Factors related to a higher percentage of unsatisfactory function were surgical incision site located above the umbilicus, gastroenterologic surgery, protracted surgery and age. Age and duration of surgery were significantly related to unsatisfactory function.


CONCLUSIONS
This study shows that continuous epidural infusion for postoperative pain was satisfactory in most cases, and that no major side-effects or complications occurred in children nursed on regular wards. The early recognition of unsatisfactory function of an EDA is important for a child's well being.
Jylli
L
L
Paediatric Anesthesia and Intensive Care, Acute Pain Treatment Service, Astrid Lindgren Children's Hospital, Karolinska Hospital, Sweden. leena.jylli@ks.se
Lundeberg
S
S
Olsson
G L
GL
D015360:Analgesia, Epidural / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies; D013997:Time Factors