Comparison of the effectiveness of intravenous fentanyl versus caudal epidural in neonates undergoing tracheoesophageal fistula surgeries

BACKGROUND: Caudal epidural has become an inseparable part of pediatric pain relief as it depresses the stress response better than any other form of analgesia, resulting in the reduction in the need for systemic opioids; in addition, it facilitates early recovery and promotes good postoperative respiratory functions. AIM: To evaluate the effectiveness of epidural analgesia in neonates undergoing tracheoesophageal fistula repair in terms of requirement of perioperative fentanyl opioid, postoperative neonatal infant pain score (NIPS), on-table extubation, duration of intubation, reintubation, perioperative hemodynamic response, and any other side effects. MATERIALS AND METHODS: A comparative, prospective, single-blind, randomized trial on 30 neonates scheduled for tracheoesophageal surgeries were randomly allocated to two groups: group I: neonates receiving caudal epidural block with ropivacaine 0.2%, 1 mg/kg bolus followed by infusion 0.1 mg/kg/h; group II: neonates receiving initial intravenous [IV] fentanyl 1 ug/kg and maintenance with 0.5 μg/kg/h IV bolus. RESULTS: None of the neonates received opioids in group I. There were statistically significant differences in the mean NIPS at 30, 60, 90, 120 150, and 240-min intervals between group I and group II. Further, 80% of neonates were extubated in group 1 compared to 50% in group II, which was statistically significant (P = 0.025). The duration of intubation was more in group II compared to group I, with a suggestive significance of P = 0.093. CONCLUSION: Caudal epidural infusion provides adequate perioperative analgesia, promotes rapid weaning from the ventilator, and contributes to a successful outcome.