Thoracic epidural anesthesia and thoracic surgery in children

Abstract

In children, postoperative analgesia after thoracic surgery is generally provided by parenteral narcotics and/or regional techniques. Regional anesthesia has gained widespread use in the management of pain in children. Both caudal and lumbar approaches to the epidural space are used extensively. Unfortunately, even though the spread of local anesthesia administered caudally or in the lumbar region has been well documented, the doses needed or required for the upper abdominal or thoracic dermatomes are high and potentially toxic. Recently, clinicians have been using the thoracic approach to the epidural space or placement of thoracic catheters through the caudal or lumbar approach. This has several advantages including, and perhaps the most important, superior pain relief. The techniques in the placement of the blocks are similar to those for adults, although some differences exist mainly in anatomical issues and drug dosages. Side effects are similar to those in adults and include the potential for spinal cord damage if dural puncture occurs, problems with the catheters, and problems associated with the use of both local anesthetics and opioids. This article will describe the experience with thoracic epidurals in children through thoracic, lumbar, and caudal approaches. A novel approach to the postoperative pain management in children after thoracic surgery is also presented.