Postoperative Dorsal Epidural Analgesia in the Child with Respiratory Disabilities

Meignier, M; Souron, R; Neel, Jean-Claude Le

doi:10.1097/00000542-198311000-00023

Cited by 72 publications

(28 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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.…”

Section: Physiologymentioning

confidence: 99%

Epidural and subarachnoid blockade in children

Rowney

Doyle

1998

Anaesthesia

View full text Add to dashboard Cite

Section: Physiologymentioning

confidence: 99%

Epidural and subarachnoid blockade in children

Rowney

Doyle

1998

Anaesthesia

View full text Add to dashboard Cite

“…The database records of all children who had received an epidural infusion over an 18 mo period (July 1,1990 to December 31, 1991) were reviewed and the complications were noted. Categories of surgery for which epi- dural analgesia was used were grouped by specialty (Table I), complications were identified by frequency (Table II), reasons for early discontinuation of epidurals were specified (Table III), and rates of occlusion and leak by catheter size were correlated (Table IV).…”

Section: Patient Is Receiving a Continuous Epidural Intusion As Tollowsmentioning

confidence: 99%

Complications of continuous epidural infusions for postoperative analgesia in children

et al. 1994

View full text Add to dashboard Cite

show abstract

“…Epidural analgesia has also been used with good success for children with a variety of persistent pain syndromes, including cancer, ~5 sickle cell vaso-occlusive crisis, 16 reflex sympathetic dystrophy, 17 and vascular insufficiency of the feet due to meningococcal purpura fulminans. , 8 A learning curve is apparent in the Alberta experience, as was found in our previous report on the introduction of paediatric epidural analgesia and related regional techniques at Boston Children's Hospital from 1986-1989.19 For example, we found three cases of heel blisters and one case of skin breakdown at the knee in a continuous passive motion device in the first 500 patients. With increased vigilance, padding of heels and side-toside turning of patients who are confined to bed for surgical indications, we have been able to prevent these blisters subsequently, so that no heel blisters have occurred among the last 1,500 children receiving epidural analgesia at our hospital.…”

Section: Epidural Analgesia In Childrenmentioning

confidence: 61%

L’analgésie épidurale chez l’enfant

Berde

1994

Can J Anaesth

View full text Add to dashboard Cite

The report in this issue by Wood et aL I chronicles the development of a paediatric epidural analgesia programme at Alberta Children's Hospital. In these authors' experience, epidural analgesia was associated with good analgesia and safety, though with a considerable incidence of side effects and technical difficulties. Readers should not be put off by the quoted incidence of "complications"; many of these occurrences were anticipated and relatively minor side effects.Recent interest in epidural analgesia in children occurs in the setting of an increased awareness of the need to provide improved pain relief for children following surgery and other forms of acute and chronic pain. Regional anaesthesia has become an important means for providing postoperative pain relief with an excellent safety and side-effect profde. 2.3 Peripheral nerve blocks are especially useful for children undergoing minor procedures as outpatients, 4 since these blocks provide analgesia with rapid emergence and a lower incidence of nausea than comparable analgesia produced by systemic opioids.Single shot caudal epidural blockade with bupivacaine is useful for providing analgesia following minor procedures below the umbilicus. With proper selection of concentration (e.g., bupivacaine 0.125 -0.25%) and dose (no more than 2.5 mg-kg-J), caudal blocks cause minimal interference with urination and motor function, and can be used safely for outpatients. 5 For more major procedures, or for procedures involving the thorax and upper abdomen, single-shot caudal blockade using bupivacaine is less effective, and the duration of analgesia is quite short. Single-shot caudal morphine (roughly 0.03 mg. kg -l for lower dermatomes or 0.05 mg. kg -I for thoracic derrnatomes) provides more prolonged analgesia and is effective for pain arising from thoracic as well as lumbo-sacral dermatomes. 6,7 Caudal analgesia with opioids is not recommended for outpatients because of a high incidence of urinary retention and a rare, but real, chance of delayed respiratory depression.Several series suggest that epidural analgesia is particularly suitable for infants and children with respiratory From the Department of Anesthesia, Boston Children's Hospital, Boston, Mass. disease. Although these series lack the fine detail and rigour of the corresponding adult studies by Kehlet, Rawal, and others, they suggest to this reviewer that paediatric epidural analgesia can provide outstanding analgesia and can facilitate postoperative recovery. Meignier s ftrst showed that thoracic epidural analgesia permitted a group of infants and children with severe pulmonary disease to undergo major thoraco-abdominal procedures with excellent recovery of pulmonary function. Ecoffey, Desparmet, Murat and their colleagues showed in a series of studies that lumbar and thoracic epidural analgesia with local anaesthetics provided excellent analgesia and haemodynamic stability. 9-11 Reports by Bt~senberg 12 and by McNeely and others in abstract form suggest improved postoperative pulmonary function r...

show abstract

Postoperative Dorsal Epidural Analgesia in the Child with Respiratory Disabilities

Cited by 72 publications

References 0 publications

Epidural and subarachnoid blockade in children

Epidural and subarachnoid blockade in children

Complications of continuous epidural infusions for postoperative analgesia in children

L’analgésie épidurale chez l’enfant

Contact Info

Product

Resources

About