Caudal catheter placement for repeated epidural morphine doses after neonatal upper abdominal surgery

Abstract

Effective pain control after major surgery in neonates presents many challenges. Parenteral opioids (and co-analgesics) are often used but inadequate analgesia and oversedation are not uncommon. Although continuous thoracic epidural analgesia is highly effective and opioid-sparing, its associated risks and the need for staff with specialised skills and/or neonatal intensive care unit staff buy-in may preclude this option even in many academic centres. We present the case of a six-day-old infant who underwent upper abdominal surgery and received intermittent morphine doses via a tunnelled caudal epidural catheter, which provided satisfactory analgesia and facilitated early extubation.

Paediatric pain management: from regional to virtual

“…The development of a structured regional anaesthesia programme in the NICU setting has been shown to significantly reduce opioid requirements and need for mechanical ventilation postoperatively [29 ▪▪ ]. Despite this, there is a need for anaesthesiologists with highly specialized skills and significant NICU staff buy-in, which may preclude use of this option at most centres [30].…”