Does the use of fentanyl in epidural solutions for postthoracotomy pain management in neonates affect surgical outcome?

Bailey, Phillip; Rose, John B.; Keswani, Sundeep G.; Adzick, N. Scott; Galinkin, Jeffrey L.

doi:10.1016/j.jpedsurg.2005.03.053

Cited by 10 publications

(8 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The risk in neonates is less clear. The risk of neonatal epidural catheters appears to be low according to epidemiologic studies and published case series (48–65) (Table 1). The risk may be further reduced with the advent of ultrasound as the ossification of the vertebral column is reduced in neonates and the cord structures are easily visualized (20).…”

Section: In Support Of Regional Analgesia: Adrian Bösenbergmentioning

confidence: 99%

Pro con debate: the use of regional vs systemic analgesia for neonatal surgery

Bösenberg

Jöhr

Wolf

2011

Pediatric Anesthesia

View full text Add to dashboard Cite

In recent years the inclusion of regional techniques to pediatric anesthesia has transformed practice. Simple procedures such as caudal anesthesia with local anaesthetics can reduce the amounts of general anesthesia required and provide complete analgesia in the postoperative period while avoiding large amounts of opioid analgesia with potential side effects that can impair recovery. However, the application of central blocks (epidural and spinal local anesthesia) via catheters in the younger infant, neonate and even preterm neonate remains more controversial. The potential for such invasive maneuvers themselves to augment risk, can be argued to outweigh the benefits, others would argue that epidural analgesia can reduce the need for postoperative ventilation and that this not only facilitates surgery when intensive care facilities are limited, but also reduces cost in terms of PICU stay and recovery profile. Currently, opinions are divided and strongly held with some major units adopting this approach widely and others maintaining a more conservative stance to anesthesia for major neonatal surgery. In this pro-con debate the evidence base is examined, supplemented with expert opinion to try to provide a balanced overall view.

show abstract

Section: In Support Of Regional Analgesia: Adrian Bösenbergmentioning

confidence: 99%

Pro con debate: the use of regional vs systemic analgesia for neonatal surgery

Bösenberg

Jöhr

Wolf

2011

Pediatric Anesthesia

View full text Add to dashboard Cite

show abstract

“…In this report, children who received an epidural infusion of bupivacaine (1 mg/ml) and fentanyl (2-5 g/ml) had a longer hospital stay, more frequent episodes of respiratory depression, and no obvious advantages in analgesia level compared with infants who received epidural bupivacaine (1 mg/ml) alone. 13 However, this report has several limitations, which include a retrospective design, a nonuniform method of pain assessment and rescue analgesic administration, use of a wide range (2-5 g/ml) of fentanyl, and lack of information on the position of epidural catheters.…”

Section: Discussionmentioning

confidence: 98%

“…9 -12 Furthermore, a recent retrospective study questioned the safety and benefits of adding fentanyl to epidural bupivacaine. 13 No randomized studies have been conducted to address these controversial issues in infants.…”

mentioning

confidence: 99%

Efficacy of Addition of Fentanyl to Epidural Bupivacaine on Postoperative Analgesia after Thoracotomy for Lung Resection in Infants

Ganesh¹,

Adzick

Foster

et al. 2008

Anesthesiology

View full text Add to dashboard Cite

show abstract

“…The puncture performed via paramedian approach, at the T6-T7 interspace in all patients, with a 22 G needle (B. Braun Melsungen AG). The epidural space identified by the loss of resistance technique (Figure 1) [7].…”

Section: Methodsmentioning

confidence: 99%

Paravertebral versus single shot epidural blockade for neonates undergoing thoracotomy

Rabie

Ghoneim

El-Rouby

2020

Egyptian Journal of Anaesthesia

View full text Add to dashboard Cite

Background and Aims: Postthoracotomy pain in neonates has negative physiological consequences include impaired ventilation and vasoconstriction of both systemic and pulmonary vascular beds leading to compromised organ function. This study aimed to compare the effect of paravertebral blockade to single shot epidural blockade on postthoracotomy pain control. Methods: A prospective study was conducted in El Shatby University Hospital, from April 2018 to March 2020 where forty neonates scheduled for a trachea-esophageal fistula (TOF) repair via thoracotomy were randomized to Group A (thoracic epidural single injection with 0.5 ml/ kg of 0.25% of L-Bupivacaine and 2 µg/kg of fentanyl) or Group B (Paravertebral blockade will be done by probe transverse -Needle In-Plane approach with 0.25% L-Bupivacaine, 0.5 ml/kg and 2 µg/kg of fentanyl). The primary objective was to compare the effect of paravertebral blockade to single shot epidural blockade on postthoracotomy pain control, the length of stay (LOS), supplemental analgesic requirements, and the incidence of adverse respiratory events were also measured. Results: Forty neonates completed the study. Group A remained hemodynamically stable in the intraoperative period with good quality of analgesia for 8 hours postoperative with a lesser doses of rescue opioids required to maintain adequate analgesia, while in group B, paravertebral analgesic effects continued for about 4 hours postoperative with multiple dosage of rescue opioids (fentanyl) was required to maintain adequate analgesia which increased length of hospital stay Conclusion: Very efficient postoperative analgesia can be achieved via single shot epidural blockade compared to paravertebral blockade in neonatal postthoracotomy pain.

show abstract

Does the use of fentanyl in epidural solutions for postthoracotomy pain management in neonates affect surgical outcome?

Cited by 10 publications

References 15 publications

Pro con debate: the use of regional vs systemic analgesia for neonatal surgery

Pro con debate: the use of regional vs systemic analgesia for neonatal surgery

Efficacy of Addition of Fentanyl to Epidural Bupivacaine on Postoperative Analgesia after Thoracotomy for Lung Resection in Infants

Paravertebral versus single shot epidural blockade for neonates undergoing thoracotomy

Contact Info

Product

Resources

About