[Epidural anesthesia in pediatrics. Apropos of 30 cases]

Abstract

Continuous epidural anesthesia was carried out in 30 children aged from 2 months to 15 years (12 are less than 5 years old) and scheduled for long surgical procedure (thoracic, abdominal or urologic procedures). The epidural space was punctured under general anesthesia on a midline approach with a saline filled syringe. The catheter is easily inserted and fixed. 28 are inserted before surgery; 2 at the end of procedure. The local anesthesia used was lidocaine 1% (with 1/200,000 epinephrine) and/or bupivacaine 0.5 alone or mixed; bupivacaine wasn't used for children aged less than 6 months. During surgery, complete sensory blockade was obtained in 26 cases; insufficient analgesia or lateralization of the block in the 2 other cases. Complete muscle paralysis, researched for 17 children, was altered for 11 patients. The insufficient was observed in upper abdominal surgery for which etidocaine was used unless the patient is aged less than 6 months (in this case lidocaine 2% was preferred). As complications, a dural penetration was observed in a child aged 2 months, and an hemodynamic instability for another patient for which 100 ml albumin was used. In the post operative period, the catheter remained in situ from 24 to 48 hours, provide safe and effective analgesia and therefore eased the management of the children.