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

Abstract

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.

Thoracic epidural analgesia and immediate extubation for less than 10 kg infants undergoing living donor liver transplantation: A report of two successful cases

“…Indeed, many centers routinely perform TEA in this setting, reporting successful IE rate in up to 80% of children. 4,7 Similarly, IE after pediatric liver transplantation has been considered a primary goal by many anesthesiologists, and a satisfactory IE rate has been achieved in some specialized pediatric liver centers, [10][11][12]25,26 ranging from 40% to more than 70%. Ulukaya et al 13 were the first to report IE in this setting.…”

“…Thong et al 4 in a large retrospective series of children undergoing major abdominal procedures (but not transplants) have shown that TEA is safe and effective, with a very small number of complications. Indeed, many centers routinely perform TEA in this setting, reporting successful IE rate in up to 80% of children 4,7 .…”

“…Although most practitioners still rely on intravenous opioids for postoperative pain control, regional and neuraxial techniques have been increasingly used for infants undergoing a variety of surgical procedures 3 . TEA, for example, has been successfully employed in the setting of cardiothoracic or major abdominal surgery, providing excellent pain relief with improved outcomes 4–7 . Unfortunately, its use for infants undergoing a liver transplant seems to lag behind, probably because of concerns about epidural hematoma.…”

“…3 TEA, for example, has been successfully employed in the setting of cardiothoracic or major abdominal surgery, providing excellent pain relief with improved outcomes. [4][5][6][7] Unfortunately, its use for infants undergoing a liver transplant seems to lag behind, probably because of concerns about epidural hematoma. This is clearly justifiable, as preoperative coagulation status is frequently abnormal due to the intrinsic liver disease.…”

Eficacia analgésica y complicaciones a corto plazo de catéteres peridurales lumbares y torácicos en pacientes pediátricos: una evaluación retrospectiva

“…Las complicaciones más frecuentes fueron problemas técnicos (12,7% de los pacientes) tales como retiro accidental del catéter, filtración de anestésico local y oclusión del catéter, las cuales determinaron el término precoz de la analgesia peridural. Estos resultados concuerdan con estudios recientes, los cuales señalan que las principales complicaciones asociadas a catéteres peridurales lumbares y torácicos fueron la desconexión, la filtración y la obstrucción (Thong et al, 2015;Walker et al, 2018). En los pacientes en los cuales hubo retiro accidental del catéter, la reinstalación de la analgesia peridural no fue realizada y ésta fue administrada de forma endovenosa mediante paracetamol y/o ketorolaco.…”