Postoperative analgesia in children with PCEA

A recent study has shown that patient-controlled epidural analgesia (PCEA) may be able to provide adequate post-operative analgesia in the paediatric population, with smaller dose requirements than continuous epidural infusion analgesia (CEA).

Until now there have been no studies conducted to evaluate the use of patient-controlled epidural analgesia (PCEA) in the paediatric population. This method of analgesia is widely used in the adult population and whilst providing adequate analgesia, it has the added benefit of using minimal local anaesthetic, hence decreasing all side-effects associated with a local anaesthetic.This study, which was published in the journal “Anesthesia & Analgesia” late last year, is the first to prospectively study CEA and PCEA by using the local anaesthetic agent ropivacaine 0.2% in children.The study group were 48 children aged 7-12yr, who were scheduled for lower extremity orthopaedic procedures lasting >30min that required major analgesia. Prior to surgery the children were taught to use the trigger of the PCEA machine. Following consent, the children were randomized to receive PCEA or CEA with ropivacaine 0.2% during the post-operative period.During the 48hour post-operative study period, the quality of pain analgesia was assessed by using a visual analog scale (VAS). A VAS score of >4 out of 10 was taken to indicate inadequate analgesia, and rescue treatment was administered. As well as the VAS pain scores, side effects were also recorded for 48hours. The study results demonstrated that either PCEA or CEA with plain ropivacaine 0.2% provided no difference in analgesia in children during the first 48hours after surgery, as evidenced by no difference in pain scores or analgesic supplemental requirement. Similarly, motor effects and side effects did not differ. However, children in the PCEA group received significantly less local anaesthetic agent than those in the CEA group.Hence this study suggests that the use of patient-controlled epidural analgesia with ropivacaine 0.2% for paediatric orthopaedic procedures has an analgesia-sparing effect in children.(Source: Anesthesia & Analgesia 2003; Volume 97: pages 1608-1611)