POSTOPERATIVE EPIDURAL ANALGESIA WITH LOW-DOSE FENTANYL, ADRENALINE AND BUPIVACAINE IN CHILDREN AFTER MAJOR ORTHOPEDIC-SURGERY - A PROSPECTIVE EVALUATION OF EFFICACY AND SIDE-EFFECTS

The efficacy and side effects of 100 lumbar epidural treatments with l ow concentrations of bupivacaine (1 mg mL(-1)), fentanyl (2 mu g mL(-1 )) and adrenaline (2 mu g mL(-1)) combined with rectal paracetamol wer e prospectively evaluated in children aged 4-14 years after femoral os teotomy. The mean treatment time was 43 h and the mean dose was 0.18 m L kg(-1) h(-1). Ninety-nine per cent of the children were either witho ut pain or experienced very low pain at rest for at least 80% of the t reatment time. The same was the case in 80% of children when pain eval uation was made on active movement. No cases of seizures, signs of cat heter migration, hypotension or respiratory depression were observed. Sixty-three per cent of the patients experienced nausea or vomiting, b ut antiemetic treatment was indicated in only 11%. One epidural treatm ent had to be stopped in a child who did not respond to antiemetics. T he incidence of pruritus was high (49%), but the symptoms were mild an d limited.