Continuous lumbar/thoracic epidural analgesia in low-weight paediatric surgical patients: practical aspects and pitfalls.
OBJECTIVE
Continuous epidural anaesthesia attenuates perioperative stress and avoids the need for systemic opioids. In addition, it may prevent the need for postoperative mechanical ventilation. The aim of the study was to prospectively follow the perioperative course of young infants treated with continuous thoracic/lumbar epidural anaesthesia for major surgery.


METHODS
Data were collected prospectively from 44 epidural anaesthetics in 40 infants (18 premature or former premature) weighing 1,400-4,300 g who underwent major abdominal surgery (33 cases), thoracic surgery (5), or both (1), or ano-rectal surgery (5) at our centre.


RESULTS
Epidural placement was achieved easily in all cases, with high quality analgesia for 24-96 h. Tracheal extubation was delayed after 4 anaesthetics due to muscle relaxant overdose (n = 1), surgeon's request (n = 2), and systemic opioid administration before epidural anaesthesia was considered (n = 1). Intraoperative complications included haemodynamic instability (n = 1) and vascular catheter placement (n = 5). Postoperative complications included meningitis (n = 1), insertion site erythema (n = 7), apnoea (n = 6; 4 premature and 2 full-term infants) and tracheal re-intubation (n = 6).


CONCLUSIONS
Continuous epidural analgesia is effective in low-weight infants undergoing major surgery. The trachea may be extubated immediately after surgery. Attention should be paid to the unique anatomical, physiological, and pharmacological aspects. The patients should be monitored carefully for pain, respiratory failure, and meningitis (an extremely rare complication).
Shenkman
Ze'ev
Z
Department of Anesthesia, Sheba Medical Center, Tel Hashomer 52561, Israel. shenk_sh@zahav.net.il
Hoppenstein
David
D
Erez
Ilan
I
Dolfin
Tzipora
T
Freud
Enrique
E
D000005:Abdomen / Q000601:surgery; D001003:Anal Canal / Q000601:surgery; D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007431:Intraoperative Complications / Q000209:etiology; D007442:Intubation, Intratracheal / Q000379:methods; D008991:Monitoring, Physiologic / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery; D012119:Respiration / Q000187:drug effects; D013514:Surgical Procedures, Operative / Q000379:methods*; D019616:Thoracic Surgical Procedures / Q000379:methods
D000779:Anesthetics, Local; D002045:Bupivacaine