Advancement of epidural catheter from lumbar to thoracic space in children: Comparison between 18G and 23G catheters

Abstract

Backgrounds and Objectives:Lumbar-to-thoracic advancement of epidural catheter is a safe alternative to direct thoracic placement in children. In this prospective randomized study, success rate of advancement of two different types and gauges of catheter from lumbar-to-thoracic space were studied.Materials and Methods:Forty ASA I and II children (up to 6 years) undergoing thoracic or upper-abdominal surgery were allocated to either Group I (18G catheter) or Group II (23G catheter). After induction of general anesthesia a pre-determined length of catheter was inserted. Successful catheter placement was defined as the catheter tip within two segment of surgical incision in radio-contrast study. Intra-operative analgesia was provided by epidural bupivacaine and intravenous morphine. Post-operative analgesia was provided with epidural infusion of 0.1% bupivacaine+1mcg/ml fentanyl.Observations and Results:Catheter advancement was successful in 3 cases in Group I and 2 cases in Group II. Five different types of catheter positions were found on X-ray. Negative correlation was found between age and catheter advancement [significance (2-tailed) =0.03]. However, satisfactory post-operative analgesia was obtained in 35 cases. Positive correlation was found between infusion rate, the number of segment of gap between desired level and the level reached [significance (2-tailed) =0.00]. 23G catheter use was associated with more technical complications.Conclusion:Advancement of epidural catheter from lumbar to thoracic level was successful in only 10-15% cases but satisfactory analgesia could be provided by increasing the infusion rates.

Comparative efficacy of continuous infusion of bupivacaine/fentanyl and ropivacaine/fentanyl for paediatric pain control after the Ravitch procedure and thoracotomy. A prospective randomized study

“…The sum of doses of metamizol as a "rescue drug" was similar in the BF and RF group (Me: 1 [0-2] vs. 1 [0-2], Z = -0.593, P = 0.552). There was also no difference between BF vs. RF in terms of the total number of interventions (Me: 6 [3][4][5][6][7][8] vs. 6 [4][5][6][7]; Z = 0.540; P = 0.588).…”

“…Analgesic mixtures containing bupivacaine and fen-tanyl or ropivacaine and fentanyl administered through a thoracic epidural catheter (TEC) are effective in relieving pain after thoracic surgery [8][9][10] . However, bupivacaine is much cheaper than ropivacaine 11 .…”

Continuous Caudal Catheters in Neonatal Population: A Focussed Review

“…However, studies have also shown migrations of the caudal epidural catheter defeating the very purpose of their placement. [4,5] On the other side of the spectrum, substantial progress has been made in our understanding of this procedure. The catheter tip placement can be confirmed by various modalities such as radiographic imaging, neurostimulation, and application of ultrasonography (US).…”