title: Patient-controlled epidural analgesia in children: can they do it?
abstract: Extensive clinical experience and many studies support the use of i.v. patient-controlled analgesia (i.v. PCA) and regional anesthesia techniques for the treatment of postoperative pain in children. In contrast, little has been reported about the ability of children to use patient-controlled epidural analgesia (PCEA) or about the efficacy of this technique. We report a descriptive analysis of prospectively recorded data in 128 children (132 procedures) in whom PCEA was used for acute postoperative pain control. Satisfactory analgesia was obtained in 119 patients (90.1%) for up to 103 h with no episodes of desaturation and without clinical evidence of toxicity or serious adverse effects. Analgesia was satisfactory with the initial settings in 89 patients; in 38 others, this was achieved with changes in PCEA settings or solution. Five patients were switched to i.v. PCA because of inadequate analgesia. Eight patients with satisfactory analgesia were converted to i.v. PCA because of adverse effects. Children as young as 5 yr had the cognitive ability to understand and the willingness to use PCEA, consistent with reported use of i.v. PCA. Careful attention should be paid to the total hourly local anesthetic dose to avoid exceeding the recommended limits. Our prospectively collected data demonstrate that PCEA provides satisfactory analgesia with a small incidence of adverse side effects in children and should be considered along with other strategies in pediatric postoperative pain management.
  
  
  CONCLUSIONS
  A descriptive analysis of prospectively recorded data in 132 children receiving patient-controlled epidural analgesia for postoperative pain relief demonstrates satisfactory analgesia without serious toxicity or side effects in children as young as 5 yr. This modality should be considered as another strategy in pediatric postoperative pain management.
authors.affiliation: Departments of *Anesthesiology, †Nursing, and ‡Pediatrics, Children's Memorial Hospital at Northwestern University Medical School, Chicago, Illinois.
authors.forename: William J
authors.initials: WJ
authors.lastname: Greeley
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Birmingham
authors.forename: Melissa
authors.initials: M
authors.lastname: Wheeler
authors.forename: Santhanam
authors.initials: S
authors.lastname: Suresh
authors.forename: Richard M
authors.initials: RM
authors.lastname: Dsida
authors.forename: Bronwyn R
authors.initials: BR
authors.lastname: Rae
authors.forename: Jennifer
authors.initials: J
authors.lastname: Obrecht
authors.forename: Vicki A
authors.initials: VA
authors.lastname: Andreoni
authors.forename: Steven C
authors.initials: SC
authors.lastname: Hall
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Coté
mesh_terms: D000293:Adolescent; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000523:psychology*; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000523:psychology*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine