Single-shot thoracic epidural analgesia for neonates undergoing thoracotomy.

Abstract

ABSTRACT Background and Aims: Post-thoracotomy pain in neonates have negative physiological consequences include impaired ventilation and vasoconstriction of both systemic and pulmonary vascular beds leading to compromised organ function. Methods: A randomized, single center, prospective, controlled study was conducted in El-Shatby university hospital, from august 2017 to September 2019 were 40 neonates, weighing 2.5–4 kg belonging to the ASA physical Grade II to IV, posted for a trachea-oesophagal fistula (TOF) repair via thoracotomy. After general anesthesia, in Group A, intra-operatively received fentanyl 2 µg/kg and paracetamol (10 mg/kg/6 h) intravenously and Group B (thoracic epidural single injection with 0.5 ml/kg of 0.25% of the L-Bupivacaine and 2 µg/kg of fentanyl), postoperatively paracetamol (10 mg/kg/6 h) intravenous (IV) or pain score >4. The primary objective was to compare the effect of the single-shot epidural blockade to intravenous fentanyl on post-thoracotomy pain control, the length of stay (LOS), supplemental analgesic requirements, and the incidence of adverse respiratory events were also measured. Results: Group A remained hemodynamically stable in the intraoperative period except for occasional bradycardia below 100 which was successfully managed with anticholinergic, and multiple and regular dosage of IV paracetamol was required to maintain adequate analgesia for about 6 h post-operative. While in Group B, good quality of analgesia for 8 h post-operative with a lesser dose of rescue opioids (fentanyl) required to maintain adequate analgesia which shortened length of hospital stay. Conclusion: Very efficient postoperative analgesia can be achieved via single-shot epidural blockade compared to intravenous fentanyl in neonatal post-thoracotomy pain.