Lumbar and thoracic epidural anaesthesia in children

Epidural anaesthetic techniques are an established part of paediatric anaesthesia. Their positive effects on general anaesthetic requirements, stay in the recovery unit, efficient perioperative pain relief and blunting of the perioperative stress response promote the routine use of regional anaesthetic techniques in children. With increasing knowledge of the anatomy and physiology of children, refinements in equipment and increased knowledge of the pharmacology of the agents used, continuous epidural catheter techniques are considered to be safe. There is some evidence that an epidural approach via the caudal and trans-sacral route is a low-risk procedure, even if the catheter is advanced to higher levels. Despite its positive effects the direct puncture at thoracic levels will probably never reach the level of routine practice. Because of its potential risks, the use of thoracic epidural anaesthesia (TEA) should be restricted to experienced paediatric anaesthetists and specialized centres.