Catriona Mclean1, Jonathan De Lima1, Gail Wong1, Kassie Cannons1, Gaynor Bennett1
1) Australia
There is paucity of contemporary Australasian literature regarding epidural analgesia in children. We have documented the pattern of use, subsequent support requirements and the incidence of adverse events attributable to epidural analgesia in a tertiary children’s hospital with an average surgical caseload of 13, 000 per year.
Following HREC approval, a retrospective review of all children receiving continuous epidural analgesia at The Children’s Hospital at Westmead over a 12 month period was conducted.
157 cases from a total of 167 epidural infusions were audited. All bar one were placed for post-operative analgesia (orthopaedic 92 (59%), general surgery 33 (21%) and spinal surgery 18 (11%)).
Epidural placement correlated well with surgical dermatome -lumbar (62%), high thoracic (19%) and low thoracic (10%). Epidural infusions were commenced with systemic opioids in 22 cases (14%) and subsequently added to a further 33 (21%).
Post-operatively, there were 224 unscheduled reviews (average per patient 1.42, range 0-5). Analgesia adjustments were required in a majority of these (an epidural bolus in 69 reviews (31%) and a rate or drug adjustment in 98 (44%) reviews.
No major complications were identified. Rates of nausea, vomiting, pruritus and respiratory events were low. There were no pressure ulcers nor urinary tract infections associated with epidural use. Most epidural infusions (85%) were completed as intended with an average duration of 3.16 days.
Technical issues (catheter dislodgement/disconnection/leak/loss of dressing integrity) occurred in 31 cases. This caused early termination of the epidural infusion in 18 cases. No epidural infections were documented.
Results suggest that continuous epidural infusions can be safe and effective in a well-supported environment that includes a dedicated Acute Pain Service, appropriately educated nursing staff and 24 hour medical cover.
Future initiatives could address technical issues (dislodgement and disconnection) and identify the role and timing of adjunctive systemic opioids.
