EPIDURAL FENTANYL INFUSION WITH PATIENT-CONTROLLED EPIDURAL ANALGESIA FOR POSTOPERATIVE ANALGESIA IN CHILDREN

The use of epidural fentanyl infusion with patient-controlled epidural analgesia (PCEA) is becoming popular for postoperative analgesia in adults. Its use has not been reported in the pediatric population. We report our initial experience with this technique in pediatric patients. The charts of all children who received epidural fentanyl infusions for postoperative analgesia between June 1991 and February 1992, were reviewed. Thirty-one patients, ages 6 to 17 years (mean ± SD, 13.2 ± 2.7) received epidural fentanyl infusion with PCEA for 36 operative procedures. Epidural catheters were either inserted in the lumbar (n = 14) or thoracic (n = 22) epidural space at a level based on the surgery. A fentanyl bolus of 1.38 ± 0.43 μg/kg was delivered via epidural catheter just prior to the conclusion of surgery. A continuous infusion of fentanyl (0.56 ± 0.18 μg/kg/h) with a PCEA bolus (0.53 ± 0.17 μg/kg) available every 15 minutes was initiated in the recovery room and was utilized for 8 to 110 hours (59 ± 27 hours). Pain and sedation were assessed by verbal descriptive scales, and side effects were noted. Alterations in dosing regimen were made for inadequate analgesia or side effects. Analgesia was assessed as excellent or good in 78% of the patients, 91% in the thoracic catheter group and 57% in the lumbar catheter group (P < .02). Patients with thoracic catheters were more likely to need their infusion and PCEA doses decreased, whereas those with lumbar catheters more often needed their doses increased (P < .05). No patient had respiratory depression. Patients in the thoracic epidural catheter group more frequently required treatment for excessive sedation. Minor side effects were at an incidence similar to that reported in other studies of epidural narcotics in children. Patients with thoracic epidural catheters placed for thoracic or upper abdominal procedures seemed to have the greatest benefit from this technique. © 1993.