heroin and Urinary-Retention

To try to decrease the incidence of side-effects associated with postoperative extradural infusions of local anaesthetics in combination with opioids, we have used plain ropivacaine solutions in 200 children. The first 72 children received an infusion of bupivacaine 0.125% + diamorphine 20 microg x ml-1, then 200 children received plain ropivacaine solutions. The children who received ropivacaine were found to have lower incidences of nausea, pruritus, urinary retention, and were less sedated, despite comparable analgesia. The management of plain ropivacaine for extradural analgesia is discussed.

Topics: Amides; Analgesics, Opioid; Anesthetics, Local; Bupivacaine; Child; Costs and Cost Analysis; Drug Combinations; Heroin; Humans; Infusions, Intravenous; Injections, Epidural; Pain, Postoperative; Postoperative Nausea and Vomiting; Pruritus; Ropivacaine; Sleep Stages; Urinary Retention

One hundred and fifty extradural infusions of diamorphine and bupivacaine after major surgery in children were audited over a 15 month period. The majority of the children (69%) were less than 5 years of age. Analgesia was assessed or self-rated as 'very good' in over 75% of patients. Urinary retention was seen in 11% of patients and pruritus in 10%. Respiratory depression requiring intervention was only seen in one patient--a premature infant of 39 weeks post-conceptual age. Technical complications resulted in the early loss of 16.7% of the infusions. Although analgesia was good the complexity of the extradural infusion technique demanded significant medical and nursing time especially to overcome technical problems.

Topics: Adolescent; Analgesia, Epidural; Bupivacaine; Child; Child, Preschool; Heroin; Humans; Infant; Infant, Newborn; London; Medical Audit; Pain, Postoperative; Patient Satisfaction; Pruritus; Respiratory Insufficiency; Treatment Outcome; Urinary Retention