• A Kotzé, W Hinton, D C G Crabbe, and B J Carrigan.
• Department of Anaesthesia, Leeds General Infirmary, UK. alwynkotze@doctors.net.uk
• Br J Anaesth. 2007 May 1;98(5):662-6.

BackgroundUncertainty remains over the risk of epidural space infection after neuraxial blockade in the presence of systemic sepsis. For many years, we have provided epidural analgesia to children undergoing thoracotomy for the decortication of parapneumonic empyemas. Following recent publications asserting that epidural analgesia is absolutely contraindicated in this situation, we audited our management. The purpose of this audit was to document the effectiveness and the incidence of complications after epidural insertion in children with active sepsis from empyemas.MethodsThis is a retrospective single-centre audit over a 10-yr period.ResultsForty-six epidurals were performed in children with empyema, and three children were treated with systemic opioids. We found no infective complications of the epidural space or insertion sites. The epidurals provided excellent analgesia. The incidence of moderate-severe pain was 18%, and 2% for severe pain in the first 24 h after surgery. Minor complications of epidural analgesia were uncommon. Two children receiving systemic opioids for pain relief suffered respiratory complications, one of which resulted in a prolonged admission to the intensive care unit.ConclusionsEpidural analgesia provides excellent pain relief after thoracotomy in children with empyema, with a low complication rate. Until evidence to the contrary emerges, it remains our technique of choice for thoracotomy, even in the presence of empyema.

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