Caudal epidural blockade in adolescents

Various options are available for the provision of analgesia following major surgical procedures including systemic opioids and regional anesthetic techniques. Regional anesthetic techniques offer the advantage of providing analgesia while avoiding the deleterious adverse effects associated with opioids including nausea, vomiting, sedation and respiratory depression. Although used commonly in infants and children, there is a paucity of experience with the use of caudal epidural blockade in adolescents. We retrospectively reviewed the perioperative care of adolescents undergoing major urologic or orthopedic surgical procedures for whom a caudal epidural block was placed for postoperative analgesia. The cohort for the study included 5 adolescents, ranging in age from 13 to 18 years and in weight from 42 to 71 kilograms. Caudal epidural analgesia was accomplished after the induction of anesthesia and prior to the start of the surgical procedure using 20-25 mL of either 0.25% bupivacaine or 0.2% ropivacaine with clonidine [1 micro g/kg]. The patients denied pain the recovery room. The time to first request for analgesia varied from 12 to 18 hours with the patients requiring 1-3 doses of analgesic agents during the initial 24 postoperative hours. Our preliminary experience demonstrates the efficacy of caudal epidural block in providing analgesia following major urologic and orthopedic surgical procedures. The applications of this technique as a means of providing postoperative analgesia are discussed

Bilateral transversus abdominis plane [TAP] catheters for postoperative analgesia in a child with spinal dysraphism

Regional analgesic techniques have become indispensable in the management of adult postoperative pain, and are gaining popularity in the pediatric population. Several case reports have been published describing the use of transversus abdominis plane [TAP] blocks for the provision of analgesia following lower and middle abdominal surgery in the adult population. Although there are several anecdotal reports and a few case series describing TAP blocks in the pediatric population, there are a limited number of reports regarding the use of continuous TAP catheters in the pediatric population. We present our experience with the use of bilateral TAP catheters to provide postoperative analgesia following major abdominal surgery [appendicovesicostomy] in a 5-year old, 17.8 kg pediatric patient with spina bifida. Applications of the technique are discussed and previous reports from the adult and pediatric population regarding the use of TAP catheters are reviewed