EPIDURAL ANALGESIA FOR MAJOR NEONATAL SURGERY

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 weigh ing 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 cas es effective analgesia was established intraoperatively. Postoperative ly analgesia was maintained by intermittent 'top-ups' (n = 170) and co ntinuous infusion (n = 10). Skin epidural distance ranged between 3 an d 12mm (mean 6.0 +/- 1.7mm) and did not correlate with the patients' w eight. Patients remained haemodynamically stable except occasional bra dycardia below 100 (n=15) which was successfully managed with antichol inergics. The potential risks and benefits of epidural analgesia in th is age group are discussed and arguments for intermittent 'top-up' dos es rather than continuous infusions presented.