Complications of continuous epidural infusions for postoperative analgesia in children

  • Catherine E. Wood
  • Gerald V. Goresky
  • Kimberly A. Klassen
  • Brian Kuwahara
  • Stuart G. Neil
Clinical Practice
  • 625 Downloads

Abstract

To determine the incidences of side effects and complications associated with the use of epidural analgesia for infants and children at the Alberta Children’s Hospital, we reviewed our experience over a two-year period. A database was established for recording management, side effects and complications of each epidural, and this is a retrospective review ofthat database. Problems were identified as complications if there was a need for medical intervention related to the patient complaint, and if the intervention was documented in the patient record. Continuous epidural analgesia with bupivacaine 0.125% or bupivacaine 0.1% with epinephrine was used for managing postoperative pain in 190 children with mean age 5.6 yr (range 1 mo to 18 yr) and the mean weight 22 kg (range 4–88 kg). Mean duration of the epidural infusions was 4.7 days (range 1–16 d). In 127 patients, 203 complications were recorded. Complications, in order of frequency, were nausea and vomiting (23% of patients), motor blockade (15.8% of patients), oversedation (6.3% of patients), and pruritus (5.2% of patients). Four patients had complications which were potentially related to toxic effects of, or resistance to, bupivacaine, and serum levels of bupivacaine were measured at 3.86, 5.5, 2.1 and 2.34 μg · ml−1. Early discontinuation of the epidural occurred in 41 cases, technical problems with the epidural catheter being the commonest reason (21 cases). Although three potentially serious complications were identified (one catheter site infection, one seizure, one respiratory depression) none was associated with lasting consequences. The majority of complications associated with the use of epidurals were minor and easily remedied. With increased experience using continuous epidurals, technical problems should diminish and consistency and reliability of the technique should improve.

Key words

Anaesthetic Techniques: epidural Anaesthesia: paediatric Analgesia: postoperative Pain: postoperative Complications: postoperative 

Résumé

Nous déterminons l’incidence des effets secondaires et des complications associées à l’analgésie épidurale chez les bébés et les enfants à l’hôpital pédiatrique d’Alberta en revoyant notre expérience sur une période de deux ans. Des données de base avaient été définies et enregistrées pour l’installation, les effets secondaires et les complications de chaque épidurale. Nous faisons une étude rétrospective de ces données. Les complications s’identifient par la nécessité d’une intervention médicale en rapport avec une plainte du patient à condition qu’elle soit documentée dans le dossier du patient. On a utilisé une analgésie épidurale continue avec de la bupivacaïne 0,125% ou 0,1% adrénalinée pour traiter la douleur post-opératoire chez 190 enfants d’âge moyen de 5,6 ans (1 mois à 18 ans) et de poids moyen de 22 kg (4–88 kg). La durée moyenne de la perfusion épidurale est de 4,7 jours (1 à 16 jours). Deux cent trois complications sont enregistrées chez 127 patients. Par ordre de fréquence, les complications sont les nausées et vomissements (23% des patients), le bloc moteur (15,8% des patients), la sédation exagérée (6,3% des patients) et le prurit (5,2% des patients). Quatre patients ont manifesté des complications en rapport avec la possibilité d’une intoxication ou d’une résistance à la bupivacaïne, et les niveaux sériques de la bupivacaïne ont été mesurés à 3,86, 5,5, 2,1 et 2,34 μg · ml−1. Un arrêt précoce de l’épidurale s’est produit pour 41 cas, la raison la plus commune étant des problèmes techniques avec le cathéter épidural. Bien que trois rations potentiellement sérieuses aient été identifiées (une infection au site du cathéter, une convulsion, une dépression respiratoire), aucune n’a été responsable de séquelles. La majorité des complications associées à l’épidurale continue sont mineures et traitées facilement. Avec une expérience accrue de l’épidurale continue, les problèmes techniques devraient diminuer, tandis que l’ejficacité et la fiabilité de cette technique devraient s’améliorer.

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Copyright information

© Canadian Anesthesiologists 1994

Authors and Affiliations

  • Catherine E. Wood
    • 1
  • Gerald V. Goresky
    • 1
  • Kimberly A. Klassen
    • 1
  • Brian Kuwahara
    • 1
  • Stuart G. Neil
    • 1
  1. 1.Department of AnaesthesiaAlberta Children’s Hospital at the University of CalgaryCalgary
  2. 2.Department of AnaesthesiaAlberta Children’s HospitalCalgary

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