Epidural analgesia improves outcome following pediatric fundoplicationA retrospective analysis

McNeely, James K.; Farber, Neil E.; Rusy, Lynn M.; Hoffman, George M.

doi:10.1016/s1098-7339(06)80051-9

Cited by 75 publications

(36 citation statements)

References 19 publications

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“…[1][2][3][4] While it is generally considered safe, major complications may arise from its use. 5 Large-scale studies conducted in adults have reported an incidence of transient or permanent neurological injury of 1-8 in 10,000 epidurals.…”

Section: Résumémentioning

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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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: Résumémentioning

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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“…In a randomized trial of infants undergoing cardiac surgery, caudal morphine and local anesthetic provided some analgesic benefits over systemic morphine, but the study had insufficient power to evaluate effects on early extubation 45 . In case series comparing perioperative neuraxial anesthesia with systemic opioid analgesia, the proportion of neonates requiring postoperative mechanical ventilation was reduced following gastrochisis repair 38 , lung resection for congenital lung lesions 46 , and Nissen fundoplication 47 . Cases of improved respiratory function following major neonatal thoracic surgery with epidural analgesia have been reported 48,49 .…”

Section: Clinical Benefits and Risks Of Neuraxial Analgesiamentioning

confidence: 99%

Neuraxial Analgesia in Neonates and Infants

Walker

Yaksh

2012

Anesthesia &Amp; Analgesia

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Neuraxial agents provide robust pain control, have the potential to improve outcomes, and are an important component of the perioperative care of children. Opioids or clonidine improve analgesia when added to perioperative epidural infusions; analgesia is significantly prolonged by addition of clonidine, ketamine, neostigmine or tramadol to single shot caudal injections of local anesthetic; and neonatal intrathecal anesthesia/analgesia is increasing in some centers. However, it is difficult to determine the relative risk-benefit of different techniques and drugs without detailed and sensitive data related to analgesia requirements, side-effects, and follow-up. Current data related to benefits and complications in neonates and infants are summarized, but variability in current neuraxial drug use reflects the relative lack of high quality evidence. Recent preclinical reports of adverse effects of general anesthetics on the developing brain have increased awareness of the potential benefit of neuraxial anesthesia/analgesia to avoid or reduce general anesthetic dose requirements. However, the developing spinal cord is also vulnerable to drug-related toxicity, and although there are well-established preclinical models and criteria for assessing spinal cord toxicity in adult animals, until recently there had been no systematic evaluation during early life. Therefore, the second half of this review presents preclinical data evaluating age-dependent changes in the pharmacodynamic response to different spinal analgesics, and recent studies evaluating spinal toxicity in specific developmental models. Finally, we advocate use of neuraxial agents with the widest demonstrable safety margin and suggest minimum standards for preclinical evaluation prior to adoption of new analgesics or preparations into routine clinical practice.

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“…1,2 The depth to the epidural space [3][4][5] and the pharmacology of local anesthetics in children are well described. 6 Suitable equipment for pediatric patients is now available.…”

mentioning

confidence: 99%

Intervertebral epidural anesthesia in 2,050 infants and children using the drip and tube method

Osaka

Yamashita

2003

Regional Anesthesia and Pain Medicine

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Epidural analgesia improves outcome following pediatric fundoplicationA retrospective analysis

Cited by 75 publications

References 19 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

Neuraxial Analgesia in Neonates and Infants

Intervertebral epidural anesthesia in 2,050 infants and children using the drip and tube method

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