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Epidural anesthesia and analgesia in the neonate: a review of current evidences

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Abstract

The role of single shot spinal anesthesia has been established in ex-premature infants at risk of apnea. However, use of epidural anesthesia in neonates is on the rise. In this systematic analysis, we have reviewed the current evidence on the safety and efficacy of the use of single shot and continuous epidural anesthesia/analgesia in neonates. Current clinical practice is guided by evidence based mostly on non-randomized studies, prospective/retrospective case series and surveys. Single shot caudal blockade as a sole technique has been used in neonates mainly for inguinal hernia repair and circumcision. Use of continuous epidural anesthesia through the caudal route or caudo-thoracic advancement of the catheter for major thoracic and abdominal surgery offers good perioperative analgesia. Other observed benefits are early extubation, attenuation of stress response, early return of bowel function and reduction of general anesthesia-related postoperative complications. However, risk of procedure-related and drug-related complications to the developing neural structure remains a serious concern.

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Authors and Affiliations

  1. All India Institute of Medical Sciences, New Delhi, India

    Souvik Maitra, Dalim Kumar Baidya, Dilip K. Pawar, Mahesh Kumar Arora & Puneet Khanna

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  1. Souvik Maitra
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  2. Dalim Kumar Baidya
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Correspondence to Dalim Kumar Baidya.

Appendix

Appendix

(“infant, newborn”[MeSH Terms] OR (“infant”[All Fields] AND “newborn”[All Fields]) OR “newborn infant”[All Fields] OR “neonate”[All Fields]) AND caudal[All Fields]

(“infant, newborn”[MeSH Terms] OR (“infant”[All Fields] AND “newborn”[All Fields]) OR “newborn infant”[All Fields] OR “neonate”[All Fields]) AND epidural[All Fields]

(“infant, newborn”[MeSH Terms] OR (“infant”[All Fields] AND “newborn”[All Fields]) OR “newborn infant”[All Fields] OR “neonate”[All Fields]) AND (“epidural anaesthesia”[All Fields] OR “anesthesia, epidural”[MeSH Terms] OR (“anesthesia”[All Fields] AND “epidural”[All Fields]) OR “epidural anesthesia”[All Fields] OR (“epidural”[All Fields] AND “anesthesia”[All Fields]))

(“infant, newborn”[MeSH Terms] OR (“infant”[All Fields] AND “newborn”[All Fields]) OR “newborn infant”[All Fields] OR “neonate”[All Fields]) AND (“analgesia, epidural”[MeSH Terms] OR (“analgesia”[All Fields] AND “epidural”[All Fields]) OR “epidural analgesia”[All Fields] OR (“epidural”[All Fields] AND “analgesia”[All Fields]))

(“infant, newborn”[MeSH Terms] OR (“infant”[All Fields] AND “newborn”[All Fields]) OR “newborn infant”[All Fields] OR “neonate”[All Fields]) AND (“regional anaesthesia”[All Fields] OR “anesthesia, conduction”[MeSH Terms] OR (“anesthesia”[All Fields] AND “conduction”[All Fields]) OR “conduction anesthesia”[All Fields] OR (“regional”[All Fields] AND “anesthesia”[All Fields]) OR “regional anesthesia”[All Fields])

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Maitra, S., Baidya, D.K., Pawar, D.K. et al. Epidural anesthesia and analgesia in the neonate: a review of current evidences. J Anesth 28, 768–779 (2014). https://doi.org/10.1007/s00540-014-1796-8

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  • DOI: https://doi.org/10.1007/s00540-014-1796-8

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