Epidural analgesia in children: planning, organization and development of a new program.
BACKGROUND
The goal of the present work is to describe the development and results of the pediatric epidural analgesia program at the ''Hospital Nacional de Pediatria Prof. Dr. J. P. Garrahan'' in Argentina.


METHODS
Patients with thoracotomy, abdominal surgery, osteotomy, amputations or severe trauma were included in the program. The program provided training to the entire staff, control and record of pain treatment and its consequences, 24 h a day availability of anesthesia staff and standard polices and procedures.


RESULTS
One hundred fifty children under 16 years of age (median age 11 years, median weight 35 kg) were included in the program during the first 18 months. The median of maximum pain reported during activity was 1 (interquartile range 1 to 4 points) using the Visual Analogue Scale (VAS) or Objective Pain Scale (OPS). Eighty seven children (CI 95% 50% to 67%) presented with postoperative nausea and vomiting, urinary retention, itching, motor blockade or sedation. No patient presented with respiratory depression, hypotension, local anaesthetic toxicity, epidural catheter related infection or death during the program evaluation. The postoperative care program enabled a 98-day reduction in treatment in the intensive care unit.


CONCLUSIONS
The safe use of pediatric epidural analgesia in general wards may require the careful selection of patients, systematic assessment by trained personnel, training of medical and nursing personnel, clear distribution of responsibilities, use of printed indications, systematic record of pain, sedation and complications, information and education of patients and parents, supply of systems for airway resuscitation and management and continuous quality control and revision of the methods.
Ingelmo
P M
PM
Department of Perioperative Medicine and Intensive Care, San Gerardo Hospital of Monza, Milano Bicocca University, Milan, Italy. p.ingelmo@hsgerardo.org
Gelsumino
C
C
Acosta
A P
AP
Lopez
V
V
Gimenez
C
C
Halac
A
A
Lira
P
P
Schon
A
A
Spagnolo
B
B
Pignataro
A
A
Nunez
G
G
Gamboa
M
M
Buquicchio
I
I
Astuto
M
M
Fumagalli
R
R
D000293:Adolescent; D015360:Analgesia, Epidural / Q000295:instrumentation; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D001118:Argentina; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D000075202:Contraindications; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D010149:Postoperative Pain / Q000628:therapy*; D010348:Patient Care Team; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine