Postoperative epidural analgesia with bupivacaine and fentanyl: hourly pain assessment in 348 paediatric cases

Background: The objective of this prospective study was the evaluation of t he analgesia provided by an epidural infusion of bupivacaine and fentanyl a fter different types of surgery in children. Methods: Data were collected from 348 epidural analgesia in 87 children bel ow 2 years of age, in 80 children between 2 and 6 years and 181 above 6 yea rs of age, for a median duration of 43 postoperative hours. Bupivacaine (me an concentration 0.185%) and fentanyl (5 mug.kg(-1).day(-1)) were administe red on the surgical ward. Results: Pain control was considered excellent in 86% of the 11 072 pain ho urly assessments. Analgesia was found to be better for children older than 2 years, and the overall quality of their night's sleep was better than tha t of older children. Higher pain scores were noted for Nissen fundoplicatio n surgery and club foot repairs. Early discontinuation rarely occurred, and only because of technical problems with the epidural catheter (4%) or insu fficient analgesia (6%). Complications were minor (nausea/vomiting 14%, pru ritus 0.6%, urinary retention 17%) and easily reversed. Conclusions: This combination of bupivacaine-fentanyl provides safe analges ia after major surgery in children with frequent clinical monitoring. Regul ar pain assessments of intensity and duration are useful to improve the qua lity of postoperative analgesia.