Regional anesthesia in pediatric surgery: Complications and postoperative comfort level in 174 children

Postoperative pain control (PPC) in children is a difficult management problem. Systemic narcotics often result in respiratory depression, while nonnarcotic analgesics are associated with inconsistent PPC. This report reviews a 29-month (January 1989 through July 1991) experience with 174 children (aged < 18 years) who received regional PPC through indwelling catheters. There were 105 males and 69 females. Patient age ranged from 1 day to 17 years 10 months (mean age, 97 months). All catheters were placed using introduction needles ranging from 24 to 16 gauge. Agents were delivered as either continuous infusion (151 patients, 87%) or bolus injections (23 patients, 13%). Analgesics were age- and weight-determined dosages of bupivicaine with or without narcotic supplementation. All patients had surgical procedures except two who had catheters placed for pain control after trauma and one who had a catheter for intractable abdominal pain of unknown etiology. Twenty-five (15%) children had thoracic incisions, 76 (43%) abdominal, 16 (9%) flank, and 54 (31%) extremity. Catheter placement included 40 thoracic epidurals (23%), 100 lumbar (57%), 27 caudal (16%), and 7 pleural (4%). Catheters were utilized for a duration of 0.5 to 8 days (mean, 2.1 ± 1.2 days). One hundred forty-four children required no additional pain medications (83%). Thirty (17%) patients required supplemental medications. Acetaminophen was used in 6 (3%), acetaminophen with codeine in 4 (2%), morphine in 18 (10%), and Percocet in 1 (1%). Minor complications occurred 21 times in 16 children (9%). Eight (5%) patients required reduction of their medication, 7 (4%) had mechanical failure of the catheter, 3 developed nausea and/or emesis (2%), 2 developed pruritus (1%), and 1 (1%) developed a urinary tract infection. One patient (1%) had a major complication of an epidural abscess that required operative drainage. These data indicate that this technique is safe and eliminates the need for systemic narcotics in the majority of children undergoing major surgical procedures (90%).