Epidemiology, effectiveness and safety of continuous caudal analgesia administered through a catheter advanced to the lumbar and thoracic regions in 19 newborns.

Continuous epidural analgesia in paediatric population is a well-accepted technique, commonly used in combination with general anesthesia. The aim of this study is to analyze , according to epidemiological, effectiveness and safety parameters, all newborns with continuous caudal infusions administered through a catheter advanced to the lumbar and thoracic regions, subjected to major thoraco-abdominal procedures in a twelve-month period, in a tertiary care hospital. 

Material and Methods: 

Retrospective analysis of all children undergoing major surgery with continuous caudal epidural technique in year 2015 in Gregorio Marañón General Hospital. 19 catheters were placed, using ultrasonography, at lumbar or thoracic cord levels. Intermittent bolus of 0,2% or 0.25% bupivacaine (0.25-0.75 ml/kg) were administered during surgery. Continuous 0,1% ropivacaine perfusion of 0,1-0,3 ml/kg/h, combined with intravenous paracetamol at a dose of 10 mg/kg/ every 8 hours, was used for post-operative pain management up to 72 hours. 

Epidemiological collected data included weight, age, associated conditions, respiratory support, type of surgery and type of incisión. Analgesic effectiveness was measured using three different parameters: morphine consumption in the Intensive Care Unit, time to extubation and beginning of oral feeding. In terms of safety, local anesthetic toxicity or technique complications were also evaluated. 
Results and discussion:  Postconceptional age ranged from 34 to 42 weeks (eleven patients were preterms). Weight ranged from 1510 to 3760 grams. Most patients had associated comorbidities. The most common type of procedure performed was bowel atresia. Just two patients needed continuous positive airway pressure. Successful pain control was achieved in eight patients. Nine of them required one or two morphine bolus and two of them needed continuous infusión of morphine. Overall, more than 50% (eleven) of patients were extubated in the operating room, and 74% of them in the first 24 hours. When indicated, oral feeding was started within 72 hours following surgery in all patients. No complications were described.

Learning points: 

Continuous epidural analgesia provides safe, reliable and efficient analgesia for both general neonates and preterms undergoing major thoraco-abdominal surgery. Caudal catheters advanced to the lumbar and thoracic regions can be used to decrease intravenous opioids and thereby allow early tracheal extubation and early oral feeding.

Epidemiology, effectiveness and safety of continuous caudal analgesia administered through a catheter advanced to the lumbar and thoracic regions in 19 newborns