Evaluating the Efficacy and Safety of Epidural Analgesia for Postoperative Pain Management in Neonates/Infants Undergoing Abdominal or Thoracic Surgery

Abstract

Introduction

The purpose of this study was to evaluate the efficacy and safety of epidural analgesia in neonates/infants after open abdominal or thoracic surgery. Efficacy was measured by recorded pain score and need for additional continuous opioid. Safety was measured by length of time infusion was administered, complications, and adverse events.

Methods

This study was a nonexperimental, descriptive, retrospective design conducted in the newborn/infant intensive care unit at an urban quaternary care pediatric hospital. Subjects were neonates/infants 0–12 months admitted after abdominal or thoracic surgery with an epidural for postoperative pain management.

Results

Ninety-four neonates/infants were identified. Patients received a continuous intravenous opioid, in addition to the epidural, 45% of the time. There was no statistically significant correlation of the addition of a continuous opioid infusion with gender (p = .83), gestational age (p = .59), or race (p = .98). The surgical site was statistically significant, with infants who had a thoracotomy requiring a continuous opioid infusion 24% of the time versus 67% of the time in those who had a laparotomy (p = .0003). There were minor complications related to epidurals 21% of the time and no adverse events. Regardless of the need for a continuous opioid infusion, pain scores were greater for all patients between 8 and 16 hours postoperatively.

Discussion

Epidural analgesia was shown to be safe and effective in surgical neonates/infants. Epidurals were most effective as monotherapy in neonates/infants after thoracotomies. The addition of a continuous opioid should be considered in all neonates/infants after laparotomies. The results of this study will help guide practice in the future, increase patient safety, and improve postoperative outcomes.

Keywords

epidural analgesia infant laparotomy neonate postoperative pain thoracotomy

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