Postoperative nerve irritation syndrome after epidural analgesia in a six-year-old child

Abstract

Morbidity after paediatric epidural anaesthesia is unusual. We report a case of transient nerve root irritation occurring after epidural analgesia for radical nephrectomy in a 6-yr-old boy who received a continuous infusion of bupivacaine 0.1%. The epidural catheter was inserted within the L2-L3 interspace under general anaesthesia. Several possible causes are discussed. Mechanical irritation of nerve roots by the epidural catheter in the epidural space is the most likely cause. Br J Anaesth 2004: 92: 146-8

Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF)

“…Only one child includes pathologies lasting months, requiring a treatment and/or having a major impact both on child’s physical and emotional status and on the quality of life of family. Neurological deficits have good outcome in children as previously reported (13,14). As reported by literature, complications are more frequent (four times in the current study) in children aged <6 months than in children aged >6 months, despite the fact that the youngest patients are probably managed by the most experienced pediatric anesthesiologists with maximal precautions.…”

Caudal blocks

“…Side effects and technical problems do occur; however, the risk of epidural infection seems to be low. In contrast to caudal anesthesia, neurologic complications (86,87) including paraplegia (88) have been reported with the lumbar approach. Lumbar catheters are not suitable to provide analgesia after abdominal or even thoracic procedures using local anesthetics alone.…”

Neuraxial Analgesia in Neonates and Infants

“…Suspected nerve injuries occurred following 1 of 364 thoracic, 2 of 1183 lumbar, and 1 of 8493 caudal epidural blocks, with no reported long-term deficits, and children were aged 8 years and above 17 . Isolated cases of neurological deficit following neuraxial anesthesia of varying severity have been reported in neonates 61 and older children 62–65 . The relative contributions of needle trauma, surgical injury, or potential drug-related toxicity to neurological injury are difficult to determine.…”