A pain control option commonly used in children undergoing a thoracotomy. A thoracotomy involves an incision on the left or right side of the chest and is usually more painful than an incision through the sternum (breastbone). A common procedure performed through a thoracotomy is an aortic coarctation repair.
An epidural catheter can be placed in children of any age, but is commonly used in children over a year of age who are likely to not need a ventilator for very long after surgery. Depending on the age of the child, the epidural catheter is placed while the child is sedated or completely under general anesthesia.
The epidural catheter is placed using a needle which is inserted in the back and slowly advanced until the correct space is located. This space is different than the one used for a "spinal tap." Once this space is located, a small flexible catheter is inserted and allows for medications to be given directly into the epidural space. Local anesthetics and narcotic medications are given to your child which block the transmission of "pain signals" from the surgical area to the spinal cord.
Children with an epidural catheter will usually have excellent pain control, better control of hypertension after aortic coarctation repair, and appear less sedated than patients receiving narcotics through an intravenous line. The Cincinnati Children's Department of Anesthesia has a pain team that is available 24 hours a day and will care for your child's epidural following surgery.
If your child is a candidate for an epidural catheter, an anesthesia team member will speak to you about this option, including risks and benefits, during the preoperative visit.
Patient-Controlled Analgesia (PCA)
A pain control option for children who are older than age 7 and are expected to be awake at the end of the surgery. In this case, a special pump will be hooked up to your child's intravenous line.
Your child will be given a button to push whenever the need for pain medication arises. The pumps are specifically programmed based on your child's weight, and it is not possible for children to overdose themselves.
It is important that your child is the only one who pushes this button. You can, however, encourage the child to use the button when necessary.
Morphine is the most commonly used medication for patient-controlled analgesia. However, if a child develops excessive itching, nausea or other side effects from morphine, your doctors may change the patient-controlled analgesia to a different narcotic.
All narcotics can cause itching and nausea. However, there are usually one or two narcotics that a patient will tolerate better than others. Once your child is able to eat, it is possible to replace the intravenous pain medication with oral (by mouth) pain medication.
Intravenous Administration of Narcotics
Used for many infants and children undergoing surgery for repair of heart disease who are too young or too sick to use the pain control methods described above. In this case, your child will be given intravenous pain medications either intermittently or as a constant infusion.
Your child's anesthesiologist, surgeon, and Cardiac Intensive Care Unit doctor will decide which medications will work best and how they will be given based on your child's condition.