Extended Postoperative Analgesia via Caudal Catheters for Major Surgery in Neonates—A 6-Year Retrospective Study

TL;DR

Caudal catheters provide effective and safe long-term pain relief for major surgeries in newborns, with no serious complications observed.

Contribution

A 6-year retrospective study on caudal catheters in neonates reveals their efficacy and safety for postoperative analgesia.

Findings

Caudal catheters provided extended analgesia with a mean duration of 135 hours and a 3% failure rate.

Neonates without intravenous opioids had shorter ICU stays compared to those who received opioids.

No infectious complications were observed despite the use of morphine in 79% of cases.

Abstract

Background: Caudal anesthesia is an important regional anesthetic technique in neonates. The placement of a catheter can provide excellent analgesia for a prolonged period; the role of adjuvants, in particular morphine, however, remains unclear. We aimed to describe our experience with caudal catheters for major surgery in neonates. Methods: We included all neonates who had a caudal catheter placed for major abdominal and thoracic surgery and explored postoperative pain management and catheter complications. This retrospective case series included neonates with caudal catheter placement from October 2012 to April 2018 at a tertiary university hospital. Results: A total of 33 caudal catheter placements in 32 neonates were included in this study, of which 28 (85%) were a laparotomy and 5 (15%) a thoracotomy. The mean catheter duration was 135 h with a postoperative failure rate of 3%. Patients who did not receive intravenous opioids postoperatively had a significantly shorter stay in the intensive care unit than those who did (341 h vs. 674 h, p = 0.01). All patients received continuous local anesthetics over the catheter, and 79% received additional intermittent epidural morphine postoperatively for a median period of 42 h. No infectious complications were reported. Conclusions: Caudal catheters are a valuable option for perioperative analgesia for major surgery in neonates. We found no serious catheter-related complication. Further research is needed to define the optimal approach and combination of different analgesic techniques.

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