Ultrasound guided continuous caudal epidural analgesia in neonates undergoing thoracotomy

Abstract

Background and Aims: Adequate postoperative analgesia guarantees adequate ventilation and minimizes respiratory complications after thoracotomy. This study compares postoperative outcomes of continuous caudal epidural blockade to systemic intravenous analgesia in neonates undergoing thoracotomy for trachea-esophageal fistula (TOF) repair. Methods: A randomized, single-center, prospective, controlled study was conducted at El-Shatby University Hospital, from August 2016 to September 2020 where 40 neonates, weighing 2.5-4 kg belonging to the ASA physical Grade II to IV, posted for a TOF repair via thoracotomy. After general anesthesia, in group A, the epidural catheter was inserted through standard caudal epidural technique. Initial bolus of 0.25% bupivacaine (0.2 ml/kg) and postoperatively continuous infusion of 0.125% bupivacaine (0.1 ml/kg/h) was given. In group B, they received fentanyl (2 μg/kg) and paracetamol (10 mg/kg) IV Intraoperatively and postoperatively paracetamol (10 mg/kg/6 h) intravenously. Results: In group A, good quality of analgesia for 48 h postoperative with a lesser doses of rescue opioids (1 µg/kg fentanyl) required to maintain adequate analgesia, which shortened the length of hospital stay compared to group B. Conclusion: Very efficient postoperative analgesia can be achieved via continuous caudally inserted epidural blockade compared to intravenous fentanyl in neonatal post-thoracotomy pain.