• A T Bösenberg.
• Department of Anaesthetics, University of Natal, Durban, South Africa.
• Paediatr Anaesth. 1998 Jan 1; 8 (6): 479-83.

AbstractSafe effective analgesia for neonates undergoing major surgery remains a challenge particularly in institutions where resources are limited. The experience in the use of epidural analgesia in 240 neonates weighing between 0.9-5.8 kg body weight (lumbar n = 211, thoracic n = 29) is reviewed. Dural puncture (n = 1), convulsion (n = 1) and intravascular migration of catheter (n = 1) were the only complications. In all cases effective analgesia was established intraoperatively. Postoperatively analgesia was maintained by intermittent 'top-ups' (n = 170) and continuous infusion (n = 10). Skin epidural distance ranged between 3 and 12 mm (mean 6.0 +/- 1.7 mm) and did not correlate with the patients' weight. Patients remained haemodynamically stable except occasional bradycardia below 100 (n = 15) which was successfully managed with anticholinergics. The potential risks and benefits of epidural analgesia in this age group are discussed and arguments for intermittent 'top-up' doses rather than continuous infusions presented.

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