Opioid Administration as Predictor of Pediatric Epidural Failure.

BACKGROUND Increasing use of regional analgesia in pediatric populations requires a better understanding of when analgesic techniques need revising or supplementation. This study was conducted to examine intra-operative opioid use as a predictor of post-operative epidural failure. METHODS Retrospective chart review of patients having epidurals placed intra-operatively. 229 epidurals were placed during the study, with 75 excluded. Dosing and quantity of opioids used intra-operatively were compared to the primary outcome of epidural failure, as well as duration of infusions and pain scores. RESULTS Opioid use was associated with increased epidural failure, particularly in less than 12 hours. However, no distinct point of certain epidural failure was found. CONCLUSIONS Opioid use after epidural loading correlates with increasing risk for epidural failure. Anesthesia providers should consider replacing or supplementing epidurals with increasing use of opioids.