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Published on: January 31, 2025
Caudal catheter placement for repeated epidural morphine doses after neonatal upper abdominal surgery
Anthony M-H Ho1, Emma Torbicki1, Andrea L Winthrop2
1Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada.
Insights
Effective pain management in newborns after major surgery is challenging. Intermittent morphine via a caudal epidural catheter provided good pain relief and allowed for early breathing tube removal in a surgical infant.
Area of Science:
- Neonatal surgery
- Pediatric pain management
- Anesthesiology
Background:
- Postoperative pain control in neonates is complex, with parenteral opioids often causing inadequate analgesia or oversedation.
- Continuous thoracic epidural analgesia is effective but carries risks and requires specialized staff, limiting its use.
Observation:
- A six-day-old infant underwent major upper abdominal surgery.
- The infant received intermittent doses of morphine through a tunnelled caudal epidural catheter for pain management.
Findings:
- The intermittent caudal epidural morphine regimen provided satisfactory analgesia.
- This approach facilitated early extubation of the infant.
Implications:
- Intermittent caudal epidural morphine may be a viable alternative for neonatal postoperative pain management.
- This technique could offer effective pain relief while potentially mitigating risks associated with continuous epidural infusions or parenteral opioids.
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.
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