Abstract
When compared with conventional analgesic techniques, epidural anaesthesia not only provides improved analgesia, but also has several beneficial effects on the postoperative respiratory, cardiovascular, and metabolic status of the patient. Although the efficacy and safety of caudal and lumbar epidural anaesthesia in children has been demonstrated, there is little information concerning the use of thoracic epidural anaesthesia. The purpose of our review was to evaluate the safety of thoracic epidural anaesthesia in infants and children. We retrospectively reviewed our three-year experience with thoracic epidural anaesthesia for postoperative analgesia in children. Epidural catheters were placed at the thoracic level without difficulty in 63 children ranging in age from three months to 18 yr and in weight from 3.2 to 78 kg. Postoperative analgesia was provided by the continuous infusion of a bupivacaine/fentanyl mixture, supplemented with intermittent epidural fentanyl by bolus as needed. Epidural catheters were successfully placed in all patients. No inadvertent dural punctures were noted. No episodes of respiratory depression related to epidural analgesia occurred. Minor adverse effects including pruritus occurred in six patients, three of whom required pharmacological intervention with diphenhydramine. Our review suggests that this is a safe and effective method of postoperative analgesia following thoracic surgery in children.
Résumé
Lorsqu’elle est comparée avec les techniques analgésiques conventionnelles, l’anesthésie épidurale procure une analgésie supérieure, mais aussi des effets cardio-vasculaires, respiratoires et métaboliques bénéfiques. Quoiqu’on ait déja démontré l’’efficacité et la sécurité de l’anesthésie caudale et épidurale lombaire en pédiatrie, on connait mal chez l’enfant l’utilisation de l’épidurale thoracique. Nous avions pour objectif d’évaluer la sécurite de l’épidurale thoracique chez le nourisson et l’enfant. Nous avons révisé de façon rétrospective notre expérience de trois ans avec l’épidurale thoracique utilisée pour produire l’analgésie post-opératoire chez l’enfant. Des cathéters épiduraux ont été installé sans difficulté au niveau thoracique chez 63 enfants dont l’âge variait entre trois mois à 18 ans et pesant de 3,2 à 78 kg. L’analgésie postopératoire a été réalisée avec une perfusion continue d’un mélange bupivacaïne/fentanyl, supplémentée au besoin par des injections intermittentes de fentanyl. Des cathéters épiduraux ont été insérés avec succès chez tous ces enfants. Il n’y a pas eu de ponction épidurale accidentelle. On n’a pas décelé de dépression respiratoire d’origine épidurale. Des effets secondaires mineurs comme le prurit sont survenus chez six patients dont trois ont été traités avec de la diphenhydramine. Cette étude suggère que cette technique est sécuritaire et efficace pour produire l’analgésie postopératoire en chirurgie thoracique pédiatrique.
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Tobias, J.D., Lowe, S., O’Dell, N. et al. Thoracic epidural anaesthesia in infants and children. Can J Anaesth 40, 879–882 (1993). https://doi.org/10.1007/BF03009262
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DOI: https://doi.org/10.1007/BF03009262