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Epidural Analgesia
The use of epidural analgesia is appropriate when systematically administered oral or parenteral analgesics do not achieve adequate pain relief without unacceptable sedation, respiratory depression, or other side effects. Epidural analgesia is now widely used for infants and children with postoperative pain. The hemodynamic and respiratory effects of major regional analgesia in infants with postoperative pain appear minimal.322 Systematic studies on epidural analgesia for children with cancer are unavailable, but experience in a few pediatric centers suggests that some children can be made comfortable with epidural or subarachnoid infusions of opioids and local anesthetics. For pediatric epidural infusion rates, the maximal recommended local anesthetic rates, per hour, are roughly 0.4 mg/kg for bupivacaine and 2 mg/kg for lidocaine. Epidural infusions that exceed those recommended rates may lead to convulsions.43 Epidural morphine has been used successfully even for young infants with cancer.45 The proper use of infusions or intermittent doses of peridural opioids or local anesthetics requires expertise and close monitoring.
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