Continuous Extradural Anaesthesia in Children

Abstract

This study reports the experience of a department of paediatric anaesthesia with 234 continuous extradural anaesthetics performed in 229 children over a 15-month period. Fifty-nine of the children were aged 0-2 yr, 71 were aged 2-8 yr and 104 were older than 8 yr. The surgical procedures lasted more than 60 min (mean 150 +/- 10.6 min); all were carried out under light general anaesthesia. Technical procedure and difficulties are reported. The only local anaesthetic agent used was bupivacaine with or without adrenaline. Mean initial dosage was 0.75 ml kg-1 for children weighing less than 20 kg and 1 ml/10 cm of height for children taller than 100 cm. Using 0.25% bupivacaine mean times until a further injection were 92.0 +/- 2.0 min for bupivacaine with adrenaline and 71.0 +/- 2.5 min for bupivacaine without adrenaline (P less than 0.001). A much longer duration of analgesia was found for younger children using the solution with adrenaline. A haemodynamic study was performed in 74 unpremedicated children (ASA I; aged 0-2 yr (n = 15), 2-8 yr (n = 26) and older than 8 yr (n = 35). Before induction of anaesthesia, heart rate (HR) was significantly increased in the youngest children, but no significant change was found for systolic arterial pressure (SAP). After extradural anaesthesia with 0.25% bupivacaine with adrenaline 1:200000, minimal changes in HR or SAP occurred in children younger than 8 yr; in those older than 8 yr a significant decrease in both HR and SAP was observed. Changes in SAP were at their maximum 25 min after the extradural block and changes in HR were not statistically significant before the 25th min following injection of local anaesthetic. The catheter remained in place in 155 children for postoperative analgesia, mainly for the first 48 h.

Epidural and subarachnoid blockade in children

“…Epidural block in children under 8 years of age is also associated with cardiovascular stability while children over 8 years of age exhibit a variable decrease in both heart rate and blood pressure [54,63,[65][66][67][68]. Significant and unexpected hypotension may still occur if there is significant hypovolaemia or a high subarachnoid block and the possibility of this side-effect requires regular blood pressure measurements for the duration of epidural analgesia.…”

Clinical signs of infection during continuous postoperative epidural analgesia in children: the value of catheter tip culture

“…Epidural catheterization for postoperative analgesia is being increasingly used in pediatric practice (1–3). Studies in adult patients have demonstrated that epidural catheters are at risk of contamination from skin flora (8–12).…”

“…The use of epidural analgesia for perioperative pain relief in children has become increasingly popular in pediatric anesthesia (1–3). In our Hospital Trust this method is used extensively for a range of surgical procedures including thoracic, orthopaedic, urology and general surgery.…”

The intravascular migration of an epidural catheter

“…In the event of subarachnoid injection hypotension in children aged over eight years and motor block of the lower limbs may occur. In view of the fact that subarachnoid injection is unlikely to produce hypotension in children of less than about eight years of age ( 13) and the difficulties in assessing motor block in the lower limbs of infants and small children the use of a test dose is not guaranteed to detect a misplaced catheter and the subsequent bolus should be administered in small increments. If epidural infusions are to be administered this should be within a setting with continuous nursing observation of the patient.…”