Analgesia and Ventilatory Response to CO2 Following Epidural Sufentanil in Children

This is a case report of an 18-month-old 10 kg child who presented for emergency repair of a recurrent diaphragmatic hernia with a history of craniofacial dystosis and was given a caudal block postoperatively with a combination of 4 ml of 0.5% bupivacaine and 2.5 micrograms.kg-1 buprenorphine made up to a total volume of 10 ml. An inadvertent dural puncture occurred resulting in total spinal block which was managed symptomatically. Block regression started one h later when the respiratory movements became noticeable. Eye opening and hand movements returned 3 h later. The patient's exposure to a large intrathecal dose of buprenorphine did not lead to prolonged respiratory depression. The possibility of a midbrain insult due to a sudden rise in intracranial pressure is also discussed.

Section: Discussionmentioning

confidence: 99%

Total spinal anaesthesia following caudal block with bupivacaine and buprenorphine

Afshan

Khan

1996

“…In our paediatric patients we have chosen ITM over previously described epidural/caudal morphine administration Uensen 1981; Glenski et al 1984;Shapiro et al 1984;Attia et al 1986 Haberer 1986;Benlabed et al 1987;Krane et al 1987;Krane 1988;Krane, Tyler & Jacobson 1989;Parkinson et al 1989;Rosen & Rosen 1989;Valley & Bailey 1991) for the following reasons. First, the technique is extremely easy and secondly the injection of opioids into free flowing cerebral spinal fluid (CSF) is indicative of correct placement and lack of contact with nerve roots.…”

Section: Discussionmentioning

confidence: 99%

Intrathecal morphine (ITM) for postoperative pain control in children: a comparison with nalbuphine patient controlled analgesia (PCA)

Krechel

Helikson

Kittle

et al. 1995

This is a retrospective study covering the ten-year period 1984-1993. Single shot spinal morphine (ITM) is compared with PCA nalbuphine for postoperative pain relief in children having abdominal or thoracic procedures. The records of 52 patients meeting selection criteria were examined. Nursing and physician notations were reviewed for hourly pain assessments, evidence of associated complications, respiratory depression, nausea and or vomiting, pruritus, and urinary retention. ITM provided significantly better pain relief (2.2 h in pain) during the first 24 h postoperatively than PCA nalbuphine (9.2 h in pain). With the exception of urinary retention which was significantly more frequent following ITM (58.6%) compared to PCA nalbuphine (8.7%), narcotic related complications were not different between the two groups. No difference in duration of hospital stay or ICU stay could be demonstrated. We conclude that ITM provides better pain relief, without more serious complications, than PCA nalbuphine. We recommend it as a safe, effective technique to treat postoperative pain in children following thoracic or upper abdominal procedures.

“…The ventilatory response to carbon dioxide following epidural sufentanil in 15 children has been studied by Benlabed et al (16). The mean onset (time from epidural administration to no pain) and duration (time from onset to moderate pain requiring an analgesic) of anal- (17) showed that time to peak plasma concentration after epidural administration of sufentanil occurred at about 20 min.…”

Section: Epidural and Intrathecal Administrationmentioning

confidence: 99%

Aspects of pharmacokinetics and pharmacodynamics of sufentanil in pediatric practice

Lundeberg

Roelofse

2010

Sufentanil is a potent synthetic opioid. Like other opioids, sufentanil creates a stable hemodynamic environment in cardiovascularly compromised pediatric patients. Clearance, expressed as per kilogram, is increased in children compared to adults. The P450 CYP3A4 enzyme is responsible for the major metabolic N-dealkylation pathway. Enzyme activity is reduced in neonates but the maturation of sufentanil clearance is not described. The free active fraction is affected by age because of the reduced α(1) -acid glycoprotein plasma concentrations in neonates. Intranasal administration of sufentanil is a possible option for premedication, procedural sedation and analgesia in children, as this option has been found to be safe and effective. Studies concerning the pharmacokinetics and dynamics of sufentanil administered as a bolus or continuous infusion in children are few.