Continuous epidural analgesia in newborn infants undergoing major surgery

Providing safe, effective analgesia for newborn infants undergoing major surgery remains a challenge to pediatric anesthetists and surgeons. Continuous epidural analgesia (CEA) has been shown to provide safe and effective analgesia in infants and children; however, there is little reported use in neonates. We review our experience of CEA in 14 newborn infants (32 to 40 weeks gestation) aged 4 hours to 35 days undergoing major surgery, as well as a further 6 ex-preterm (25 to 29 weeks gestation) infants aged 2 to 5 months at time of surgery. In all cases effective analgesia was achieved for up to 69 hours without complication. All infants were awake and extubated uneventfully at the completion of surgery, which lasted 5 hours in one case. None of the infants developed respiratory depression or prolonged apnea. The technique has been widely accepted by surgeons, neonatal nursing staff, and neonatologists.