Table 2 Regimens for continuous epidural analgesia reported in the literature

Cassady [16]

Reg Anesth Pain Med

2000

RCT

33

At the midpoint of the incision and advanced 3–5 cm cephalad

Bupivacaine 0.25% with epinephrine 1:200,000, 10 ml, 15 min before skin closure

Bupivacaine 0.125% (0.35 mg/kg/h) and fentanyl 2.5 μg/ml (0.7 μg/kg/h), 0.28 ml/kg/h, within 30 min of arrival in the PACU

None

Tobias [42]

Paediatr Anaesth

2001

Observational

14

Upper catheter: at the T6–8 level with the tip directed cephalad to T1–4.

Lower catheter: at the T12 level with the tip directed caudad to the L1–4 level.

Fentanyl 1 μg/kg and hydromorphone 5 μg/kg were diluted in 0.3 ml/kg of saline. Following placement, the upper and lower catheters were dosed with 0.1 ml/kg and 0.2 ml/kg of the solution, respectively. After tracheal extubation and neurologic examination, the catheters were dosed with 0.1 ml/kg of ropivacaine 0.2% (upper catheter) and 0.2 ml/kg of ropivacaine 0.2% (lower catheter)

Ropivacaine 0.1% and hydromorphone 10 μg/ml at 0.1 ml/kg/h into the upper catheter and 0.2 ml/kg/h into the lower catheter, started after the bolus doses of ropivacaine

None

Blumenthal [40]

Anesthesiology

2005

RCT

30

Upper catheter: at the cranial end of the wound and the tip directed 4–5 cm cephalad to T1–4. The lower catheter was inserted at the caudal end of the wound, and the tip was directed 4–5 cm to a position at L1–4.

Ropivacaine 0.3% 4–8-ml boluses through each catheter.

Ropivacaine 0.3% 4–10 ml/h in each catheter after the bolus doses of ropivacaine

None

O’Hara [31]

Paediatr Anaesth

2004

RCT

31

At the midpoint of the incision and advanced 3–5 cm cephalad

Bupivacaine 0.1% or 0.065% + fentanyl 5 μg/ml, 3 ml, before conclusion of surgery

Bupivacaine 0.1% or 0.065% + fentanyl 5 μg/ml, 4 ml/h, after the bolus of epidural solution before conclusion of surgery

None

Saudan [41] Paediatr Anaesth

2008

Observational

98

Single: the catheter tip was in the center of the surgical site.

Double: the cranial catheter was set between thoracic levels T4 and T6 and the lower catheter between T10 and L1

Bupivacaine 0.25% with epinephrine 1:200,000 as a test dose after surgery. Bupivacaine 0.125%, 1.6 ml/kg as a loading dose in the absence of adverse events.

Bupivacaine 0.0625%, fentanyl 1 μg/ml, and clonidine 0.6 μg/ml, 0.2 ml/kg/h, in the recovery area

Doses of 0.1 ml/kg/h. Lockout time: 15 min, a maximal hourly bolus rate, 2

Gauger [20]

J Pediatr Orthop

2009

RCT

38

At the midpoint of the incision and advanced 3–5 cm cephalad

Fentanyl 1 μg/kg and hydromorphone 5 μg/kg diluted in 0.3 ml/kg of saline, intraoperatively

Bupivacaine 0.1% + hydromorphone 10 μg/ml, 8 ml/h, on arrival in the PACU and after a neurologic examination

Bolus dose of 2 ml allowed every 30 min

Klatt [25]

Spine (Phila Pa 1976)

2013

RCT

66

Single: at the midpoint of the incision and advanced 3–5 cm cephalad

Double: the upper catheter was placed at the junction of the proximal and middle thirds of the instrumented spine and advanced 5 cm cephalad. The lower catheter was placed at the junction of the middle and distal thirds of the instrumented spine and advanced 5 cm cephalad.

Bupivacaine 0.1% and fentanyl 2 μg/ml, 0.2 ml/kg (single) or 0.1 ml/kg in each catheter (double), with initiation of wound closure

Bupivacaine 0.1% + fentanyl 2 μg/ml, 0.2 ml/kg/h (single) or bupivacaine 0.1% + fentanyl 2 μg/ml, 0.1 ml/kg/h in each catheter (double), upon arrival to the PACU

Demand dose of 0.1 ml/kg, lockout time 1 h (allowed only via the caudal catheter in the double catheter group)

Erdogan [43]

Spine (Phila Pa 1976)

2017

RCT

44

At the midpoint of the incision and advanced 5–6 cm cephalad to T4 to T5

Morphine 50 μg/kg in a PCIEA group and 20 μg/kg in a PCCEA group

No continuous infusion in the PCIEA group and morphine 10 μg/kg/h in the PCCEA group

50 μg/kg/h with a 1-h lockout in PCIEA group and 5 μg/kg bolus dose with a 30-min lockout interval and 4-h limit of 4 mg