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COMMENTARY
Year : 2015  |  Volume : 59  |  Issue : 10  |  Page : 640-641  

Continuous epidural analgesia for post-operative pain relief in paediatric patients


21, Jagadambal st, T. Nagar, Chennai, Tamil Nadu, India

Date of Web Publication19-Oct-2015

Correspondence Address:
Nagasamy Venkateswaran
21, Jagadambal st, T. Nagar, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


PMID: 26644610

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How to cite this article:
Venkateswaran N. Continuous epidural analgesia for post-operative pain relief in paediatric patients. Indian J Anaesth 2015;59:640-1

How to cite this URL:
Venkateswaran N. Continuous epidural analgesia for post-operative pain relief in paediatric patients. Indian J Anaesth [serial online] 2015 [cited 2019 Oct 20];59:640-1. Available from: http://www.ijaweb.org/text.asp?2015/59/10/640/167489

The safety of epidural analgesia in paediatric patients has been well established. It was used as a single shot technique for intra and immediate post-operative pain relief, which helped to reduce the requirement of potent opiate analgesics with their attendant unwanted side effects. There was some initial hesitation in using continuous epidural techniques by placing a catheter in paediatric population because of the fear of local anaesthetic systemic toxicity(LAST) and the immaturity of enzyme systems of the liver to metabolize the local anaesthetic agents, especially in neonates and pre-maturely born infants.[1] Several studies and review papers have proved this fear to be unfounded, and no serious complications have been encountered in practice. Hence, the exclusion of neonates and infants from receiving this continuous technique for post-operative pain relief is no longer advocated.

The second consideration to avoid any complications from this technique is whether to institute this block in the awake or the anaesthetized patient. Studies have again established that there are no differences in the rate of complications between awake versus asleep patients and that performing the block in patients under general anaesthesia is equally safe.[2]

The third criterion for not using this technique as a routine is the lack of Intensive Care Unit beds for monitoring the patients who have continuous epidural analgesia. It is now well-established that if proper training is providedto nursing staff to monitor patients, they can be managed in the ward with no increase in morbidity and mortality.[3]

However, to ensure the safety of this practice of using continuous technique as a routine for post-operative pain relief, the following measures should be strictly adhered to:

  • Proper-sized needles and catheters must be available for safe administration of regional blocks
  • Anaesthesiologists permitted to perform the blocks must be well-versed in the dosage of local anaesthetic drugs, their potential complications and management of them. Trainees should perform the blocks only under supervision
  • Use of Ultrasound to locate the needle, catheter placement and spread of the drug will help in avoiding complications [4],[5]
  • Proper documentation of the procedure, which should include demographic details, block performed, number of attempts, procedural complications such as bloody/wet tap, success or failure of block, LAST and post-operative neurological sequelae, will help in minimizing the complications by identifying the areas of mistakes.


 
   References Top

1.
PatelD. Epidural analgesia for children. Contin Educ Anaesth Crit Care Pain 2006;6:63-6.  Back to cited text no. 1
    
2.
TobiasJD, SchrockC, GrecoC. St. Louis Children's Hospital Boston Children's Hospital. Vol.6. 2008. Available from: http://www.anestesiarianimazione.com/2008/01e.asp.[Last accessed on 2015Apr05].  Back to cited text no. 2
    
3.
EllisJA, MartelliB, LaMontagneC, SplinterW. Evaluation of a continuous epidural analgesia program for postoperative pain in children. Pain Manag Nurs 2007;8:146-55.  Back to cited text no. 3
    
4.
KarmakarMK, LiX, HoAM, KwokWH, ChuiPT. Real-time ultrasound-guided paramedian epidural access: Evaluation of a novel in-plane technique. Br J Anaesth 2009;102:845-54.  Back to cited text no. 4
    
5.
FurnessG, ReillyMP, KuchiS. An evaluation of ultrasound imaging for identification of lumbar intervertebral level. Anaesthesia 2002;57:277-80.  Back to cited text no. 5
    




 

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