Culture of bacteria from lumbar and caudal epidural catheters used for postoperative analgesia in children

McNeely, James K.; Trentadue, Noreen C.; Rusy, Lynn M.; Farber, Neil E.

doi:10.1016/s1098-7339(97)80028-4

Cited by 84 publications

(41 citation statements)

References 8 publications

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“…Previous studies have shown a variable association between caudal epidurals and infection. 19,[22][23][24][25] In children, duration of catheterization appears to be the most significant factor associated with epidural site infection. 24,25 One study showed 13 infections in 10,653 epidurals, all of which occurred from days three to 11 after catheter insertion.…”

Section: Discussionmentioning

confidence: 99%

“…24 Methods to reduce infection may include the use of antibiotic prophylaxis and the timing of antibiotic administration prior to epidural insertion, although the latter remains controversial. [23][24][25][26][27] Alcohol-based skin preparation solutions have been reported to be more effective than aqueous solutions for the prevention of central venous line infections in intensive care settings; [28][29][30] however, findings for the prevention of infectious complications related to epidural catheters have been inconsistent. 22,25,31,32 Ultrasound-guided regional analgesia was introduced to our practice in 2008.…”

Section: Discussionmentioning

confidence: 99%

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Major complications related to epidural analgesia in children: a 15-year audit of 3,152 epidurals

Wong

Arab

Chew

et al. 2013

Can J Anesth/J Can Anesth

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Background Complications associated with epidural analgesia in children have a reported incidence of 40-90 in 10,000 epidurals. We sought to determine the incidence of major complications with the use of continuous epidural analgesia that occurred in our centre over the past 15 years and to describe the nature of these complications. Methods The Acute Pain Service database at a tertiary care academic pediatric hospital was reviewed retrospectively over a 15-year period. Data were categorized according to patient age (neonate, infant, child one through eight years, and child [ eight years), mode of insertion of the epidural (caudal, transsacral, lumbar, thoracic), complication type, and complication severity. Results Over the 15-year period, 3,152 epidurals were performed. The use of caudal-thoracic epidurals in neonates and infants has increased since 2007. Twenty-four major complications were identified (incidence, 7.6 in 1,000 epidurals). The rate of complications in neonates

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Major complications related to epidural analgesia in children: a 15-year audit of 3,152 epidurals

Wong

Arab

Chew

et al. 2013

Can J Anesth/J Can Anesth

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“…As the rate of catheter colonisation by bacteria is higher in caudal catheters, we prefer the thoracic approach to epidural analgesia. (11,12) To the best of our knowledge, there are few studies on epidural analgesia in young children. Earlier studies of neuraxial techniques used on infants arose from a need to avoid general anaesthesia in high-risk groups.…”

Section: Discussionmentioning

confidence: 99%

Infant lumbar and thoracic epidurals for abdominal surgeries: cases in a paediatric tertiary institution

Thong¹,

Sin²,

Chan³

et al. 2015

smedj

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INTRODUCTIONThere 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. METHODSThe 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.CONCLUSION 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.

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“…auch motorische Blockade sowie eine länger anhaltende postoperative Analgesie im Vergleich zur ausschließli-chen Verwendung eines Lokalanästheti-kums. Dies ist gerade vor dem Hintergrund von großer Bedeutung, dass kontinuierliche Blockaden mit Katheter wegen der Risiken von Infektionen nur beschränkt indiziert sind [74]. Ferner sollen Zusätze niedrigere Lokalanästhe-tikakonzentrationen bei gleichen Blockadequalitäten ermöglichen.…”

Section: Zusätzeunclassified

Kaudalanästhesie

2003

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Caudal anaesthesia is the most frequently used regional technique in paediatric anaesthesia. Caudal in combination with general anaesthesia is usually performed in healthy children (i.e. for herniotomy or hypospadias). Therefore every complication of this method is a catastrophe, even when the incidence of these complications is very low. Some of the documented complications of caudal anaesthesia in children are caused by the local anaesthetic solutions and/or by additives. Thus, the choice of substances for paediatric caudal blocks should minimize the risk associated with the substances used for this indication. Over the last decades the standard was bupivacaine but because of serious cardiovascular and central-nervous toxicity following inadvertent intravascular injection of bupivacaine during caudal puncture, the less toxic ropivacaine should be favoured for this indication. A huge number of clinical studies have proven the clinical effectiveness and safety of ropivacaine also for this indication. In addition, levobupivacaine, the L-enantiomere of bupivacaine, will also be an interesting local anaesthetic in the future for paediatric caudal anaesthesia. By using additives to local anaesthetics better analgesic properties should be obtained. Following an exact review of the literature, only clonidine and S(+)-ketamine are useful additives to local anaesthetics in paediatric caudal anaesthesia.

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Culture of bacteria from lumbar and caudal epidural catheters used for postoperative analgesia in children

Cited by 84 publications

References 8 publications

Major complications related to epidural analgesia in children: a 15-year audit of 3,152 epidurals

Major complications related to epidural analgesia in children: a 15-year audit of 3,152 epidurals

Infant lumbar and thoracic epidurals for abdominal surgeries: cases in a paediatric tertiary institution

Kaudalanästhesie

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