Opioid administration as predictor of pediatric epidural failure

Background: Increasing use of regional analgesia in pediatric populations requires a better understanding of when analgesic techniques need revising or supplementation. This study was conducted to examine intra-operative opioid use as a predictor of post-operative epidural failure. Methods: Retrospective chart review of patients having epidurals placed intra-operatively. 229 epidurals were placed during the study, with 75 excluded. Dosing and quantity of opioids used intra-operatively were compared to the primary outcome of epidural failure, as well as duration of infusions and pain scores. Results: Opioid use was associated with increased epidural failure, particularly in less than 12 hours. However, no distinct point of certain epidural failure was found.. Conclusions: Opioid use after epidural loading correlates with increasing risk for epidural failure. Anesthesia providers should consider replacing or supplementing epidurals with increasing use of opioids.