title: Epidural analgesia for major neonatal surgery.
abstract: Safe effective analgesia for neonates undergoing major surgery remains a challenge particularly in institutions where resources are limited. The experience in the use of epidural analgesia in 240 neonates weighing between 0.9-5.8 kg body weight (lumbar n = 211, thoracic n = 29) is reviewed. Dural puncture (n = 1), convulsion (n = 1) and intravascular migration of catheter (n = 1) were the only complications. In all cases effective analgesia was established intraoperatively. Postoperatively analgesia was maintained by intermittent 'top-ups' (n = 170) and continuous infusion (n = 10). Skin epidural distance ranged between 3 and 12 mm (mean 6.0 +/- 1.7 mm) and did not correlate with the patients' weight. Patients remained haemodynamically stable except occasional bradycardia below 100 (n = 15) which was successfully managed with anticholinergics. The potential risks and benefits of epidural analgesia in this age group are discussed and arguments for intermittent 'top-up' doses rather than continuous infusions presented.
authors.affiliation: Department of Anaesthetics, University of Natal, Durban, South Africa.
authors.forename: A T
authors.initials: AT
authors.lastname: Bösenberg
mesh_terms: D015360:Analgesia, Epidural / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D006801:Humans; D007231:Infant, Newborn; D010149:Postoperative Pain / Q000188:drug therapy; D013514:Surgical Procedures, Operative
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine