The Risk of Infection from Epidural Analgesia in Children: A Review of 1620 Cases

Strafford, Maureen A. MD; Wilder, Robert T. MD, PhD; Berde, Charles B. MD, PhD

Pediatric Anesthesia

We reviewed cases to determine whether suspected or confirmed epidural infection was associated with epidural analgesia for 1620 infants, children, and adolescents treated over a 6-yr period at Children's Hospital, Boston. Postoperative patients (1458/1620) received epidural infusions for a median of 2 days (range, 0-8 days). No postoperative patient had an epidural abscess. One 10-yr-old with terminal malignancy received thoracic epidural analgesia via two successive catheters over a 4-wk period. She had Candida colonization of the epidural space along with necrotic epidural tumor. A second oncology patient and two patients with reflex sympathetic dystrophy were evaluated for epidural abscess, but none was found. We conclude that the risk of epidural infection is quite low in pediatric postoperative patients receiving short-term catheterization. Use of prolonged epidural analgesia in the management of chronic pain in children requires careful monitoring of warning signs of infection.

(Anesth Analg 1995;80:234-8)

Department of Anaesthesia, Harvard Medical School, and Department of Anesthesia, Children's Hospital, Boston, Massachusetts.

This work was supported in part by a grant from the Anesthesia Patient Safety Foundation and a contribution from the Christopher Coakley Memorial Fund.

Accepted for publication October 6, 1994.

Address correspondence to Charles B. Berde, MD, PhD, Department of Anesthesia, Children's Hospital, 300 Longwood Avenue, Farley 3 South, Boston, MA 02115.

© 1995 International Anesthesia Research Society