Junyi Ren1,2, Francis Masoo*²
1.Department of Anesthesiology, Baoji Central Hospital, Baoji, China
2.Department of Anesthesiology, Mzuzu Central Hospital, Mzuzu, Malawi
- Corresponding author: Francis Masoo; Email: francismasoo111@gmail.com
Abstract
Background
Caudal epidural anesthesia is one of the most commonly used regional anesthetic techniques in pediatric practice. However, reports describing continuous caudal epidural anesthesia as the primary anesthetic technique for prolonged neonatal upper abdominal surgery remain scarce. We report the successful use of continuous caudal epidural anesthesia combined with intravenous sedation in a neonate undergoing a 3.5-hour upper abdominal operation.
Case Presentation
A 25-day-old male neonate weighing 2.5 kg presented with duodenal obstruction, intestinal malrotation, annular pancreas, and pulmonary infection. Because of the patient’s pulmonary infection, immature respiratory physiology, and the potential risks associated with general anesthesia, continuous caudal epidural anesthesia combined with intravenous sedation was selected as the primary anesthetic technique.
After intravenous sedation with ketamine, a 22-gauge catheter was inserted through the sacral hiatus into the caudal epidural space. Following negative aspiration, 3 mL of 0.25% bupivacaine was administered. The patient subsequently underwent Roux-en-Y duodenojejunostomy and Ladd procedure. Approximately three hours later, regression of the block was managed with an additional 2.5 mL of 1% lidocaine through the epidural catheter.
The operation lasted approximately 3.5 hours and was completed without conversion to general anesthesia. Oxygen saturation remained above 90% throughout the procedure, and hemodynamic parameters remained stable. No respiratory complications, neurological deficits, local anesthetic toxicity, or catheter-related complications were observed. The patient was discharged on postoperative day seven without complications.
Conclusion
Continuous caudal epidural anesthesia combined with intravenous sedation provided effective anesthesia for prolonged neonatal upper abdominal surgery while avoiding routine endotracheal intubation. This technique may represent a practical alternative for selected neonatal patients, particularly in resource-limited settings.
Keywords: Neonate; Continuous caudal epidural anesthesia; Upper abdominal surgery; Bupivacaine; Lidocaine