title: Patient-controlled epidural analgesia versus continuous epidural infusion with ropivacaine for postoperative analgesia in children.
abstract: Epidural ropivacaine infusion has been used in children; however, patient-controlled epidural analgesia (PCEA) has not been evaluated in the pediatric population. In this study, we compared the clinical efficiency of PCEA and of continuous epidural infusion analgesia (CEA) in children. Forty-eight children undergoing orthopedic surgery were randomized to receive PCEA or CEA with ropivacaine 0.2%. All patients underwent a standard general anesthetic. Children also received ketoprofen and propacetamol. Pain scores and side effects were recorded for 48 h. If the visual analog score scale score was >4 of 10, analgesia was considered inadequate, and rescue treatment was administered. Both groups obtained effective pain relief. Children in the PCEA group received significantly less local anesthetic than those in the CEA group (0.20 +/- 0.08 mg x kg(-1) x h(-1) versus 0.40 +/- 0.08 mg x kg(-1) x h(-1); P < 0.001). Motor effects, supplemental analgesic requirements, and side effects did not differ. We concluded that PCEA with ropivacaine 0.2% can provide adequate postoperative analgesia for pediatric orthopedic procedures with smaller dose requirements than CEA.
  
  
  CONCLUSIONS
  We studied patient-controlled epidural analgesia (PCEA) and continuous epidural infusion analgesia (CEA) with 0.2% ropivacaine during the postoperative period in children. We found that either PCEA or CEA with plain ropivacaine 0.2% provided adequate pain relief in children during the first 48-h postoperative course. However, adequate analgesia was obtained with 50% less volume infused with PCEA compared with CEA.
authors: *Service d'Anesthésie-Réanimation, Hôpital de l'Hôtel-Dieu et Debrousse, Lyon, France; and †Department of Anesthesiology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
authors: Emmanuel
authors: E
authors: Antok
authors: Fabienne
authors: F
authors: Bordet
authors: Frédéric
authors: F
authors: Duflo
authors: Sabine
authors: S
authors: Lansiaux
authors: Sylvie
authors: S
authors: Combet
authors: Patricia
authors: P
authors: Taylor
authors: Agnes
authors: A
authors: Pouyau
authors: Brigitte
authors: B
authors: Paturel
authors: Robert
authors: R
authors: James
authors: Bernard
authors: B
authors: Allaouchiche
authors: Dominique
authors: D
authors: Chassard
mesh_terms: D000577:Amides / Q000008:administration & dosage / Q000009:adverse effects; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine