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PEDIATRIC ANESTHESIA

Tunneled Epidural Catheters for Prolonged Analgesia in Pediatric Patients

Laleh Aram, MD^*, Elliot J. Krane, MD^*, Lori J. Kozloski, RN, PNP, and Myron Yaster, MD^||

Departments of *Anesthesia and Pediatrics, Stanford University, Stanford, California; Department of Anesthesiology, Pediatric Pain Service; and Departments of Anesthesiology, Critical Care Medicine, and ||Pediatrics, the Johns Hopkins Medical Institutions, Baltimore, Maryland

Address correspondence and reprint requests to Elliot J. Krane, MD, Departments of Anesthesia and Pediatrics, Stanford University School of Medicine, 300 Pasteur Dr., Stanford, CA 94305-5640. Address e-mail to krane{at}stanford.edu

We conducted this retrospective study to document the efficacy and safety, and demonstrate the spectrum of indications for subcutaneously tunneled epidural catheters in the management of prolonged pain in pediatric patients. The charts of 25 patients with prolonged pain that was unresponsive to conventional opioid therapy (10: end stage malignancy, 8: extensive abdominal surgery, 7: trauma, etc.) and who received thoracic, lumbar, or caudal tunneled epidural catheters between 1995 and 1999 were reviewed for efficacy and catheter-related complications (infection or bleeding at the insertion site, toxicity related to local anesthetics, tachyphylaxis and respiratory depression). Tunneled epidural catheters were effective in providing extended analgesia in all subjects. In 14 patients with chronic pain, cumulative 48-h enteral and parenteral opioid requirements were reduced or eliminated after catheter insertion. Catheters remained in place for a median of 11 days (range, 4–240 days) until there was no further need for parenteral analgesia (n = 15), death because of the underlying disease (n = 6), accidental removal (n = 2), or possible infection (n = 2). No serious local or systemic complications (meningitis, epidural abscess, systemic infection, epidural hematoma, or spinal cord injury; seizures, local anesthetic toxicity) occurred related to this technique. Five patients were discharged from the hospital with the catheter for home analgesic therapy. The use of a percutaneously inserted, subcutaneously tunneled epidural catheter is safe, effective, and provides pain relief in situations in which conventional analgesic therapy either fails or is impractical. The technique is one that may be of great value to children suffering from pain.

Implications: Children and adolescents with pain may safely have a spinal catheter placed for a period of time without undo risk of infection or other complications. Spinal catheters provide excellent pain relief, often eliminating the need for riskier medications for painful events such as wound cleansing and dressing changes.

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