Post-operative epidural analgesia with low dose fentanyl, adrenaline and bupivacaine in children after major orthopaedic surgery. A prospective evaluation of efficacy and side effects

The efficacy and side effects of 100 lumbar epidural treatments with low concentrations of bupivacaine (1 mg mL(-1)), fentanyl (2 mu g mL(-1)) and adrenaline (2 mu g mL(-1)) combined with rectal paracetamol were prospectively evaluated in children aged 4-14 years after femoral osteotomy. The mean treatment time was 43 h and the mean dose was 0.18 mL kg(-1) h(-1). Ninety-nine per cent of the children were either without pain or experienced very low pain at rest for at least 80% of the treatment time. The same was the case in 80% of children when pain evaluation was made on active movement. No cases of seizures, signs of catheter migration, hypotension or respiratory depression were observed. Sixty-three per cent of the patients experienced nausea or vomiting, but antiemetic treatment was indicated in only 11%. One epidural treatment had to be stopped in a child who did not respond to antiemetics. The incidence of pruritus was high (49%), but the symptoms were mild and limited.