Tunneled epidural catheters for prolonged analgesia in pediatric patients

We conducted this retrospective study to document the efficacy and safety, and demonstrate the spectrum of indications for subcutaneously tunneled epi dural catheters in the management of prolonged pain in pediatric patients. The charts of 25 patients with prolonged pain that was unresponsive to conv entional opioid therapy (10: end stage malignancy 8 extensive abdominal sur gery, 7: trauma, etc.) and who received thoracic, lumbar, or caudal tunnele d epidural catheters between 1995 and 1999 were reviewed for efficacy and c atheter related complications (infection or bleeding at the insertion site, toxicity related to local anesthetics, tachyphylaxis and respiratory depre ssion). Tunneled epidural catheters were effective in providing extended an algesia in all subjects. In 14 patients with chronic pain, cumulative 48-h enteral and parenteral opioid requirements were reduced or eliminated after catheter insertion. Catheters remained in place for a median of 11 days (r ange, 4-240 days) until there was no further need for parenteral analgesia (n = 15), death because of the underlying disease (n = 6), accidental remov al (n = 2), or possible infection (n = 2). No serious local or systemic com plications (meningitis, epidural abscess, systemic infection, epidural hema toma, or spinal cord injury; seizures, local anesthetic toxicity) occurred related to this technique. Five patients were discharged from the hospital with the catheter for home analgesic therapy. The use of a percutaneously i nserted, subcutaneously tunneled epidural catheter is safe, effective, and provides pain relief in situations in which conventional analgesic therapy Either fails or is impractical. The technique is one that may be of great v alue to children suffering from pain.