{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T02:22:44Z","timestamp":1779243764366,"version":"3.51.4"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,12,10]],"date-time":"2019-12-10T00:00:00Z","timestamp":1575936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Objectives<\/jats:title><jats:p>Epidural analgesia is an effective, established perioperative intervention in all age\u2010groups. In children, however, epidural\u2010related data are limited compared to the adult population. The aim of this study was to examine the use of pediatric epidural analgesia in our institution and, thereby, add to the existing data pool.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methodology<\/jats:title><jats:p>Patients who received epidural analgesia as part of their perioperative management between 1996 and 2016 at Great Ormond Street Hospital, London, UK, were studied to determine how epidural practice has changed over time, associated incidence of serious adverse events, complications, and patient\/parent satisfaction. Epidural use and monitoring were in accordance with standard hospital protocols. Data were prospectively collected and entered into a secure database by trained personnel. These data were subsequently extracted for retrospective analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 3876 patients were included. The median age was 4.4\u00a0years (range 1\u00a0day to 20\u00a0years), and the median weight was 20.3\u00a0kg. Across all age\u2010groups, the lumbar region was the most common site of epidural insertion while urology (42.2%) and general surgery (37.3%) were the specialities for which it was most utilized. Over the study period, the number of epidurals performed declined while the number of surgical procedures performed simultaneously increased. The infusate most commonly used was local anesthetic with preservative\u2010free morphine (71.9%). In 923 (23.2%) patients, systemic opioids were additionally used for analgesic management by means of patient\u2010controlled analgesia or nurse\u2010controlled analgesia. There was one serious adverse event in the form of permanent nerve injury, giving an overall incidence of approximately 1:3800. Other complications included postoperative nausea and vomiting (35.9%), urinary retention (4.4%), and pruritus (31%). Overall global satisfaction with the service was generally high, with 95% providing a rating of \u201cvery good\u201d or \u201cgood.\u201d<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study evaluated two decades of epidural practice in our institution. Epidural analgesia remains a safe, effective option for postoperative analgesia, but its use has declined over time, and this trend is likely to continue. Rates of serious adverse events and complications were low and comparable to those published in other similar studies. Global satisfaction among patients\/parents remains high.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.13767","type":"journal-article","created":{"date-parts":[[2019,11,16]],"date-time":"2019-11-16T14:34:55Z","timestamp":1573914895000},"page":"25-33","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Evolving pediatric epidural practice: An institution's clinical experience over 20 years\u2014A retrospective observational cohort study"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1654-4750","authenticated-orcid":false,"given":"Akhil","family":"Gupta","sequence":"first","affiliation":[{"name":"Department of Anaesthesia University Hospital Lewisham Lewisham UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2481-7755","authenticated-orcid":false,"given":"Matthew A.","family":"Jay","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Pain Medicine Great Ormond Street Hospital for Children London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6684-2540","authenticated-orcid":false,"given":"Glyn","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Pain Medicine Great Ormond Street Hospital for Children London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,12,10]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.4103\/0970-9185.92409"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjaceaccp\/mkl001"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12988"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1460-9592.2001.00597.x"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000002372"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2007.02230.x"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-012-9877-3"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5049.167494"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2011.03731.x"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1460-9592.2003.00951.x"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2009.03242.x"},{"key":"e_1_2_8_13_1","first-page":"539","volume-title":"The Great Ormond Street Hospital Manual of Children's Nursing Practices","author":"Macqueen S","year":"2012"},{"key":"e_1_2_8_14_1","first-page":"144","volume-title":"Epidural Analgesia","author":"Bromage PR","year":"1978"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aew403"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/2010105817733997"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOP.0b013e32810c8eaf"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aew387"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aet379"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2010.03448.x"},{"key":"e_1_2_8_21_1","unstructured":"The 3rd national audit project of the Royal College of Anaesthetists. 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