Bravenboer-Monster Klarieke, Keyzer-Dekker Claudia, van Dijk Monique, Staals Lonneke, Leeuw Tom de, Wijnen Rene
Department of Pediatric Surgery, ErasmusMC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Anaesthesiology, ErasmusMC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Eur J Pediatr Surg. 2019 Apr;29(2):209-214. doi: 10.1055/s-0038-1632372. Epub 2018 Feb 19.
Epidural analgesia (EDA) is used as postoperative pain treatment in children, but little is known about its efficacy after laparotomy in children. This retrospective study investigated the efficacy of postoperative EDA after laparotomy in children and the frequencies of adverse effects and complications.
Data of all children aged 0 to 18 years undergoing laparotomy and treated with EDA in our hospital from January 2014 to December 2015 were collected. EDA was classified as successful either if the catheter was removed when there was no further need, and the patient was comfortable with oral/rectal analgesics or when EDA was continued after intervention.
Ninety children with a median age of 3.7 years were included in the study. In 65% (59/90), EDA was classified as successful. In 34% (20/59) of all successful cases, an additional intervention was needed. In 35% (31/90), the catheter was removed earlier than planned, in half of these cases after an intervention. The primary reason for earlier removal was inadequate analgesia and technical failure. Adverse effects occurred in 18% and complications in 1% of cases. The successful group was significantly younger than the unsuccessful ( = 0.003).
EDA after laparotomy positively contributed to postoperative pain treatment in two-thirds of children. Numbers of adverse effects and complications were low. It is important to optimize pain management after laparotomy in children; thus, further prospective studies should focus on optimizing EDA and comparing EDA with other techniques of analgesia.
