title: Safety and efficacy of patient controlled epidural analgesia following pediatric spinal surgery.
abstract: BACKGROUND
  Patient controlled epidural analgesia (PCEA) is uncommon in pediatric anesthesia. Because PCEA offers superior pain control compared with continuous epidural infusions in adults, we prospectively evaluated the analgesia efficacy and safety of PCEA in children and adolescents following extensive spinal surgery.
  
  
  METHODS
  Following ethics committee approval, 100 consecutive children [age median (range) 14 (6-19) years] undergoing spinal surgery were studied until the seventh postoperative day, and 98 children received a PCEA. One or two epidural catheters were positioned under direct vision by the surgeon based on the number of vertebral segments operated upon. The epidural solution consisted of bupivacaine 0.0625%, fentanyl 1 microg.ml(-1) and clonidine 0.6 microg.ml(-1), delivered at a basal rate of 0.2 ml.kg(-1).h(-1) and a PCEA dose of 0.1 ml.kg(-1).h(-1)(max. 2 h(-1)). On the fourth postoperative day, PCEA was stopped and analgesia was continued with patient controlled analgesia (PCA) with morphine.
  
  
  RESULTS
  During the PCEA regimen, the maximal scores of the revized facial scale were below 4 at rest with a very high satisfaction rate (>90%). Pain scores were higher during mobilization on the first postoperative day and when PCEA was switched to PCA. The overall incidence of adverse events was low and consisted primarily of technical problems and postoperative nausea and vomiting. Only two children experienced a complication requiring the discontinuation of the PCEA but there were no consequent adverse sequelae.
  
  
  CONCLUSIONS
  The present study demonstrates that PCEA provides excellent pain relief following extensive spinal surgery and is associated with a low incidence of adverse events. The use of PCEA should be encouraged in children and adolescents following extensive spinal surgery.
authors.affiliation: Pediatric Anesthesia Unit, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Sonja
authors.initials: S
authors.lastname: Saudan
authors.forename: Walid
authors.initials: W
authors.lastname: Habre
authors.forename: Dimitri
authors.initials: D
authors.lastname: Ceroni
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Meyer
authors.forename: Robert S
authors.initials: RS
authors.lastname: Greenberg
authors.forename: André
authors.initials: A
authors.lastname: Kaelin
authors.forename: Britta S
authors.initials: BS
authors.lastname: von Ungern-Sternberg
mesh_terms: D000293:Adolescent; D000328:Adult; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects*; D000768:Anesthesia, General; D000779:Anesthetics, Local; D002045:Bupivacaine; D002648:Child; D006801:Humans; D010149:Postoperative Pain / Q000188:drug therapy*; D010372:Pediatrics; D020250:Postoperative Nausea and Vomiting; D011446:Prospective Studies; D012600:Scoliosis / Q000601:surgery
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine