Does the use of fentanyl in epidural solutions for postthoracotomy pain management in neonates affect surgical outcome?

• Published in: Journal of pediatric surgery 2005-07, Vol.40 (7), p.1118-1121
• Main Authors: Bailey, Phillip D., Rose, John B., Keswani, Sundeep G., Adzick, N. Scott, Galinkin, Jeffrey L.
• Format: Article
• Language: English
• Subjects: Adjuvants, Anesthesia - adverse effects; Adjuvants, Anesthesia - therapeutic use; Analgesics - therapeutic use; Anesthesia, Epidural - adverse effects; Anesthesia, Epidural - methods; Anesthetics, Local - therapeutic use; Bupivacaine - therapeutic use; Cystic Adenomatoid Malformation of Lung, Congenital - surgery; Fentanyl - adverse effects; Fentanyl - therapeutic use; Humans; Infant; Infant, Newborn; Length of Stay; Lung - drug effects; Pain; Retrospective Studies; Thoracotomy; Treatment Outcome
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2005.03.053

Continuous epidural analgesia is routinely used to manage pain in infants undergoing resection of a congenital cystic adenomatoid malformation (CCAM) of the lung. Our aim was to determine if there is a difference in the length of stay (LOS), supplemental analgesic requirements, pain control, and the incidence of adverse respiratory events in infants receiving the 2 standard epidural solutions commonly used: bupivacaine 0.1% and bupivacaine 0.1% with fentanyl 2 to 5 μg/mL. We retrospectively reviewed the charts of infants who received epidural infusions containing bupivacaine 0.1% (n = 18) and bupivacaine 0.1% with fentanyl 2 to 5 μg/mL (n = 10) after CCAM resection during a 12-month period. LOS, rescue opioid, and nonopioid analgesic use, incidence of respiratory depression, and pain scores were recorded. The LOS in patients receiving fentanyl in their epidural solution was 1 day longer than those receiving plain bupivacaine (median 4 vs 3 days, respectively). Nonopioid analgesic and rescue opioid use was greater in patients who did not have fentanyl in their epidural solutions. Pain ratings were not significantly different. The incidence of respiratory depression was greater in patients receiving epidural infusions containing fentanyl (50% vs 17%, respectively). The addition of fentanyl to epidural infusions of bupivacaine in infants undergoing thoracotomy for resection of CCAM may prolong recovery and increase the incidence of adverse respiratory events without providing a significant analgesic benefit.