Audit of epidural analgesia in children undergoing thoracotomy for decortication of empyema

Background: Uncertainty remains over the risk of epidural space infectionafter neuraxial blockade in the presence of systemic sepsis.For many years, we have provided epidural analgesia to childrenundergoing thoracotomy for the decortication of parapneumonicempyemas. Following recent publications asserting that epiduralanalgesia is absolutely contraindicated in this situation, weaudited our management. The purpose of this audit was to documentthe effectiveness and the incidence of complications after epiduralinsertion in children with active sepsis from empyemas. Methods: This is a retrospective single-centre audit over a 10-yr period. Results: Forty-six epidurals were performed in children with empyema,and three children were treated with systemic opioids. We foundno infective complications of the epidural space or insertionsites. The epidurals provided excellent analgesia. The incidenceof moderate–severe pain was 18%, and 2% for severe painin the first 24 h after surgery. Minor complications of epiduralanalgesia were uncommon. Two children receiving systemic opioidsfor pain relief suffered respiratory complications, one of whichresulted in a prolonged admission to the intensive care unit. Conclusions: Epidural analgesia provides excellent pain relief after thoracotomyin children with empyema, with a low complication rate. Untilevidence to the contrary emerges, it remains our technique ofchoice for thoracotomy, even in the presence of empyema.