Epidural analgesia in children.

The report in this issue by Wood et aL I chronicles the development of a paediatric epidural analgesia programme at Alberta Children's Hospital. In these authors' experience, epidural analgesia was associated with good analgesia and safety, though with a considerable incidence of side effects and technical difficulties. Readers should not be put off by the quoted incidence of "complications"; many of these occurrences were anticipated and relatively minor side effects. Recent interest in epidural analgesia in children occurs in the setting of an increased awareness of the need to provide improved pain relief for children following surgery and other forms of acute and chronic pain. Regional anaesthesia has become an important means for providing postoperative pain relief with an excellent safety and side-effect profde. 2.3 Peripheral nerve blocks are especially useful for children undergoing minor procedures as outpatients, 4 since these blocks provide analgesia with rapid emergence and a lower incidence of nausea than comparable analgesia produced by systemic opioids. Single shot caudal epidural blockade with bupivacaine is useful for providing analgesia following minor procedures below the umbilicus. With proper selection of concentration (e.g., bupivacaine 0.125 0.25%) and dose (no more than 2.5 mg-kg-J), caudal blocks cause minimal interference with urination and motor function, and can be used safely for outpatients. 5 For more major procedures, or for procedures involving the thorax and upper abdomen, single-shot caudal blockade using bupivacaine is less effective, and the duration of analgesia is quite short. Single-shot caudal morphine (roughly 0.03 mg. kg -l for lower dermatomes or 0.05 mg. kg -I for thoracic derrnatomes) provides more prolonged analgesia and is effective for pain arising from thoracic as well as lumbo-sacral dermatomes. 6,7 Caudal analgesia with opioids is not recommended for outpatients because of a high incidence of urinary retention and a rare, but real, chance of delayed respiratory depression. Several series suggest that epidural analgesia is particularly suitable for infants and children with respiratory