Regional Anesthesia for Neonates

Abstract

The consequences of inadequate regulation of pain were made evident by early clinical studies showing that anesthesia and analgesia reduced morbidity and mortality after cardiac surgery in the newborn. As well as deleterious acute physiological consequences, there is an evolving literature indicating that neonatal surgery and/or intensive care can result in prolonged changes in sensory processing and altered responses to future pain. Traditionally intravenous morphine or other opioids are used, but these mandate ventilatory support and close monitoring in a neonatal intensive or similar high care unit. In contrast, regional anesthesia comes closest to achieving complete analgesia in both ventilated and spontaneously breathing neonates. Most regional blocks are placed during general anesthesia to ensure an immobile patient. In certain situations, however, spinals, epidurals, caudal catheters and peripheral nerve blocks have been placed in “awake” neonates. However sedation or conversion to general anesthesia is generally required for major abdominal surgery. ___________________________ Key Words: highlight the benefits, recommended doses, possible risks, complications and recommendations of regional anesthesia for neonates