Eur J Pediatr Surg
DOI: 10.1055/s-0038-1632372
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Efficacy of Epidural Analgesia after Laparotomy in Children

Klarieke Bravenboer-Monster
1  Department of Pediatric Surgery, ErasmusMC-Sophia Children's Hospital, Rotterdam, The Netherlands
,
Claudia Keyzer-Dekker
1  Department of Pediatric Surgery, ErasmusMC-Sophia Children's Hospital, Rotterdam, The Netherlands
,
Monique van Dijk
1  Department of Pediatric Surgery, ErasmusMC-Sophia Children's Hospital, Rotterdam, The Netherlands
,
Lonneke Staals
2  Department of Anaesthesiology, ErasmusMC-Sophia Children's Hospital, Rotterdam, The Netherlands
,
Tom de Leeuw
2  Department of Anaesthesiology, ErasmusMC-Sophia Children's Hospital, Rotterdam, The Netherlands
,
Rene Wijnen
1  Department of Pediatric Surgery, ErasmusMC-Sophia Children's Hospital, Rotterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

10 October 2017

16 January 2018

Publication Date:
19 February 2018 (eFirst)

Abstract

Background 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.

Materials and Methods 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.

Results 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 (p = 0.003).

Conclusion 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.