Workshop: Epidural management

Introduction Epidural blockade in children continues to grow in popularity with increasing applications in the operating room and beyond. In infants and children, epidural anesthesia is most commonly performed in conjunction with general anesthesia as a means of providing postoperative analgesia or as a combined general-regional anesthetic technique to limit the requirements for general anesthetic agents. However, epidural blockade may also be the sole surgical anesthetic in various clinical scenarios such as the former premature infant at high risk for post-anesthetic apnea, in patients with concurrent medical conditions that increase the potential risks of general anesthesia, or in cooperative older pediatric patients who chose a regional anesthetic technique over general anesthesia. When performed preemptively prior to surgical incision, epidural blockade may ablate the surgical stress response, decrease postoperative analgesia requirements, and improve the postoperative course. Epidural anesthesia has also found increasing roles in the management of acute and chronic pain outside of the perioperative period. Additionally, the sympathetic blockade that can be induced by epidural anesthesia is occasionally used as a therapeutic tool to improve regional blood flow in various clinical scenarios with associated vascular insufficiency. This workshop will review local anesthetic agents, opioids, and adjuvant agents commonly used for pediatric epidural anesthesia/analgesia and discuss the practical aspects of these techniques. Additionally, specific issues as they pertain to the use of these techniques in neonates will be reviewed.