title: The safety of concurrent administration of opioids via epidural and intravenous routes for postoperative pain in pediatric oncology patients.
abstract: Supplementation of epidural opioid analgesia with intravenous opioids is usually avoided because of concern about respiratory depression. However, the choice of adjunct analgesic agents for pediatric oncology patients is limited. Antipyretic drugs may mask fever in neutropenic patients, and nonsteroidal anti-inflammatory agents may exert antiplatelet effects and interact with chemotherapeutic agents. We examined the safety of concurrent use of epidural and intravenous opioids in a consecutive series of 117 epidural infusions in pediatric patients and compared our findings to those reported by other investigators. We observed a 0.85% rate of clinically significant respiratory complications. The single adverse event was associated with an error in dosage. In our experience, the supplementation of epidural opioid analgesia with intravenous opioids has been a safe method of postoperative pain control for pediatric patients with cancer.
authors.affiliation: Division of Anesthesia and Pain Management Service, Division of Patient Care Services, St. Jude Children's Research Hospital, Memphis, TN 38105-2794, USA. doralina.anghelescu@stjude.org <doralina.anghelescu@stjude.org>
authors.forename: Doralina L
authors.initials: DL
authors.lastname: Anghelescu
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Ross
authors.forename: Linda L
authors.initials: LL
authors.lastname: Oakes
authors.forename: Laura L
authors.initials: LL
authors.lastname: Burgoyne
mesh_terms: D000293:Adolescent; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D009369:Neoplasms / Q000601:surgery*; D010149:Postoperative Pain / Q000188:drug therapy*; D012131:Respiratory Insufficiency / Q000139:chemically induced
chemical_list: D000701:Analgesics, Opioid