Epidural catheters for tethered cord repair patients.

 

1. Epidural catheters for tethered cord patients are inserted under direct visualization by the neurosurgery team.  As such there is little doubt that the catheter is in the right spot for the pain control. We suggest dosing the catheter in the same way that we dose other epidural catheters using the formulas described in our “epidural catheter” section.  A max dose should be used for the patients weight.  We suggest however that a maximum infusion rate should not exceed 6cc/hour to start – no matter how big the child is. 

 

2. If pain control is not effective, there are two options. A) if the child weighs more that 15 Kg, the infusion may be increased to as much as 9cc/hour using the max dose of 0.4mg/kg/hour of Bupivacaine as the upper limit for infusion rate.  This strategy will require a recheck of the child in 1-2 hours to assess the effectiveness of this change. B) if the infusion is already at max rate for weight - then consider adding an PCA or intermittent bolus opiate for additional pain control.