title: Infant lumbar and thoracic epidurals for abdominal surgeries: cases in a paediatric tertiary institution.
abstract: BACKGROUND
  There is strong evidence that epidural analgesia provides good postoperative pain relief in adults, but its use in infants is less established. In this retrospective study, we present our experience with managing infant epidural analgesia for abdominal surgeries in a tertiary paediatric institution.
  
  
  METHODS
  The records of 54 infants who had received a thoracic or lumbar epidural as perioperative analgesia for abdominal surgeries were included. The mean age of the infants was 6.1 (standard deviation [SD] 3.8) months and their mean weight was 6.8 kg (SD 1.8). Most (63%) had an ASA (American Society of Anesthesiologists) status of 2 and all underwent elective gastrointestinal, urogenital, hepatobiliary or retroperitoneal surgeries. 20 catheters (37.0%) were inserted in the thoracic region and 33 (61.1%) in the lumbar region.
  
  
  RESULTS
  A total of 52 (96.3%) catheters provided adequate intraoperative analgesia and 36 (66.7%) provided effective analgesia for the postoperative period. Active management of epidural analgesia, such as through epidural top-ups and infusion rate adjustment, was necessary to optimise analgesia in 22 (44%) of the 50 patients postoperatively. Reasons for premature catheter removal were mainly technical issues such as catheter disconnection, leakage and blockage.
  
  
  CONCLUSIONS
  Our data suggests that in experienced hands, specialised settings and active management, the success rate of epidural analgesia in infants undergoing major abdominal surgeries is high and without major incident.
authors: Department of Anaesthesia, Singapore General Hospital, Singapore.
authors: Sze Ying
authors: SY
authors: Thong
authors: Department of General Surgery, Singapore General Hospital, Singapore.
authors: Eliza I-Lin
authors: EI
authors: Sin
authors: Department of Anaesthesia, Singapore General Hospital, Singapore.
authors: Diana Xin Hui
authors: DX
authors: Chan
authors: Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore.
authors: Jagdish M
authors: JM
authors: Shahani
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000698:Analgesia / Q000379:methods; D015360:Analgesia, Epidural / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008159:Lumbar Vertebrae; D008297:Male; D010149:Postoperative Pain / Q000517:prevention & control; D010372:Pediatrics / Q000379:methods*; D059035:Perioperative Period; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013904:Thoracic Vertebrae; D016896:Treatment Outcome
keywords: abdominal surgery; infant epidural; postoperative analgesia