THORACIC EPIDURAL-ANESTHESIA IN INFANTS AND CHILDREN

When compared with conventional analgesic techniques, epidural anaesth esia not only provides improved analgesia, but also has several benefi cial effects on the postoperative respiratory, cardiovascular and meta bolic status of the patient. Although the efficacy and safety of cauda l and lumbar epidural anaesthesia in children has been demonstrated, t here is little information concerning the use of thoracic epidural ana esthesia The purpose of our review was to evaluate the safety of thora cic epidural anaesthesia in infants and children. We retrospectively r eviewed our three-year experience with thoracic epidural anaesthesia f or postoperative analgesia in children. Epidural catheters were placed at the thoracic level without difficulty in 63 children ranging in ag e from three months to 18 yr and in weight from 3.2 to 78 kg. Postoper ative analgesia was provided by the continuous infusion of a bupivacai ne/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 res piratory depression related to epidural analgesia occurred Minor adver se 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 an algesia following thoracic surgery in children.