When compared with conventional
analgesic techniques, epidural anaesthesia not only provides improved
analgesia, but also has several beneficial effects on the postoperative respiratory, cardiovascular, and metabolic status of the patient. Although the efficacy and safety of caudal and lumbar epidural anaesthesia in children has been demonstrated, there is little information concerning the use of thoracic epidural anaesthesia. The purpose of our review was to evaluate the safety of thoracic epidural anaesthesia in infants and children. We retrospectively reviewed our three-year experience with thoracic epidural anaesthesia for postoperative
analgesia in children. Epidural
catheters were placed at the thoracic level without difficulty in 63 children ranging in age from three months to 18 yr and in weight from 3.2 to 78 kg. Postoperative
analgesia was provided by the continuous infusion of a
bupivacaine/
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
respiratory depression related to
epidural analgesia occurred. Minor adverse 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
analgesia following thoracic surgery in children.