2011 - ISBTS 2011 Symposium


This page contains exclusive content for the member of the following sections: TTS, ITA. Log in to view.

Oral Communications 5: Long Term TPN and Rehab

7.142 - Epidural analgesia following intestinal lengthening procedures - serial transverse enteroplasty (STEP) and bianchi procedures

Presenter: Clarivet, Torres, Washington, United States
Authors: Clarivet Torres1, Sarah Reece-Stremtan1, Ira Cohen1, Alla Alla Tauber1, Anthony Sandler1, Yewande Johnson1

142
Epidural analgesia following intestinal lengthening procedures - serial transverse enteroplasty (STEP) and bianchi procedures

Clarivet Torres, Sarah Reece-Stremtan, Ira Cohen, Alla Alla Tauber, Anthony Sandler, Yewande Johnson

Division of Anesthesiology and Pain Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Division of General Surgery, Children’s National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, United States

Mu-opioid agonists decrease peristalsis and increase transit time through the intestine, which may be especially deleterious in patients with baseline decreased gut function. Epidural analgesia inhibits afferent pain signals and efferent sympathetic reflex arcs when used intra- and postoperatively which potentially has a beneficial effect on gut motility. This is especially important in intestinal failure parenteral nutrition dependent patients with severe reduced baseline intestinal motility. Intestinal lengthening (IL) procedures have shown improved enteral tolerance in children with SBS. Although long-term bowel motility is preserved with the STEP procedure, an early complication is possible bowel obstruction. Thus, the concern remains for use of parenteral opioids postoperatively in patients undergoing these procedures. Here we report a series of patients that have undergone IL procedure with epidural analgesia.

Methods: From 2009-2011, seven children, ages 7-35 months, underwent IL procedures for SBS with epidural (thoracic or lumbar) placement for intra-operative and postoperative analgesia. Patients received epidural ropivacaine with or without fentanyl as well as general inhalation anesthesia during surgery; the infusions were changed to a ropivacaine 0.1%/fentanyl 2mcg/mL mixture postoperatively. Epidural analgesia was continued at the rate of 0.4cc/kg/hr until post-operative day 4-5. Intravenous opioids for breakthrough pain were available while the epidural catheter was in place

Results: All children tolerated well epidural analgesia. Only one patient required supplemental intravenous opioids while the epidural catheter was infusing. No patients required IV opioids after discontinuation of the epidural catheter. Enteral feeding was begun between postoperative days 7-11. All patient families expressed satisfaction with the pain control their children received. There were no complications secondary to epidural placement and no patients incurred postoperative bowel obstruction.

Conclusions: Epidural analgesia should be considered as a modality for analgesia children undergoing bowel lengthening surgery, it reduces the need of Mu-opioid agonists and its secondary effects.


Important Disclaimer

By viewing the material on this site you understand and accept that:

  1. The opinions and statements expressed on this site reflect the views of the author or authors and do not necessarily reflect those of The Transplantation Society and/or its Sections.
  2. The hosting of material on The Transplantation Society site does not signify endorsement of this material by The Transplantation Society and/or its Sections.
  3. The material is solely for educational purposes for qualified health care professionals.
  4. The Transplantation Society and/or its Sections are not liable for any decision made or action taken based on the information contained in the material on this site.
  5. The information cannot be used as a substitute for professional care.
  6. The information does not represent a standard of care.
  7. No physician-patient relationship is being established.

Social

Contact

Staff Directory
+1-514-874-1717
info@tts.org

Address

The Transplantation Society
International Headquarters
740 Notre-Dame Ouest
Suite 1245
Montréal, QC, H3C 3X6
Canada