NM-295
Caudal epidural catheters for postoperative analgesia in a developing country: A case series.
hubbard R, Argote-Romero G, Burrier C, Tobias J
Nationwide Children's Hospital, Columbus, Ohio, USA
Introduction: The provision of postoperative analgesia remains challenging in many developing nations, where issues of limited resources, technology, and skilled manpower may limit the capacity to provide tertiary care services [1]. Voluntary medical services from abroad (VMSA) provide an opportunity for complex surgical care which may be beyond the capacity of local institutions [2]. However, with invasive surgical interventions comes the need to provide effective postoperative analgesia, a topic which has been largely ignored.
Methods: As part of a pediatric urologic VMSA to Costa Rica, patients undergoing feminizing genitoplasty and vaginal reconstruction had placement of a caudal epidural catheter for postoperative pain control using an AmbIT® home infusion pump (Summit Medical Products, Sandy, Utah). Their postoperative course was retrospectively reviewed.
Results: Three patients ranging in age from 4 to 11 years had caudal epidural catheters placed following the induction of anesthesia. A bolus dose of local anesthetic (either bupivacaine or levo-bupivicaine) with additives (fentanyl or clonidine) was administered intraoperatively and a continuous infusion (0.125% bupivacaine with clonidine 0.5 µg/mL) was infused postoperatively using the home infusion pump. All patients achieved adequate pain control postoperatively. The catheters remained in place until postoperative day 2 or 3. Motor blockade developed in one patient and the infusion was paused for 2 hours and restarted at a lower rate. In one patient, the infusion bag ran out, resulting in pain and the need for a secondary bolus prior to restarting the infusion. No other complications were noted.
Discussion: While pain management is a critical aspect of anesthetic care for complex surgeries conducted by VMSAs in developing countries, the use of advanced regional anesthesia techniques remains limited. A single report documents the use of peripheral nerve catheters in such environments [3]. We present a case series on the use of caudal epidural infusions for complex urologic procedures in children. Satisfactory pain control was achieved in all three patients, with no significant side effects reported.
Conclusion: Caudal epidural catheters have the potential to provide safe and effective analgesia for children undergoing pelvic surgery in austere environments.
Bibliography
1.Schnittger T. Regional anesthesia in developing countries.
Anaesthesia 2007;62:44-7.
2.Fisher AQ, Politis GD, Tobias JD, et al. Pediatric anesthesia for
voluntary services abroad. Anesth Analg 2002:95;336-50.
3.Mariano E, Ilfeld B, Cheng G, Nicodemus H, Suresh S.
Feasibility of ultrasound-guided peripheral nerve block
catheters for pain control on pediatric medical missions in
developing countries. Pediatr Anesth 2008;18:598-601.
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