The Role of Regional Anesthesia in Neonatal Care: A Review
Main Article Content
Abstract
Effective pain management in neonates is critical, as inadequate treatment can result in both immediate complications and long-term cognitive and behavioral issues. Neonates, particularly preterm infants, have heightened sensitivity to pain, which necessitates the use of specialized pain management techniques. Regional anesthesia (RA) offers significant benefits in this patient population, including reducing the need for opioids and their associated risks, minimizing the stress response, and improving postoperative outcomes. Despite its proven efficacy in pediatric and adult populations, there is limited published evidence regarding RA's use in neonates. This article reviews the fundamental science, clinical applications, and safety considerations of regional anesthesia in neonates, focusing on four modalities: neuraxial blocks, peripheral nerve blocks, fascial plane blocks, and analgesic catheters. While RA has been shown to provide superior pain control and reduce opioid consumption, safety is paramount, especially considering the unique physiological characteristics of neonates.
Article Details
How to Cite
E., Balverde Camiño; F., Terra Laurent; F., Cristiani Halty.
The Role of Regional Anesthesia in Neonatal Care: A Review.
Medical Research Archives, [S.l.], v. 12, n. 10, oct. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5927>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v12i10.5927.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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2. Grunau RE, Holsti L, Peters JW. Long-term consequences of pain in human neonates. Semin Fetal Neonatal Med. 2006;11(4):268-275. doi:10.1016/j.siny.2006.02.007
3. Anand KJS, Papanicolaou AC, Palmer FB. Repetitive neonatal pain and neurocognitive abilities in ex-preterm children. Pain. 2013;154(10):1899-1901. doi:10.1016/j.pain.2013.06.027
4. Simons SH, van Dijk M, Anand KS, Roofthooft D, van Lingen RA, Tibboel D. Do we still hurt newborn babies? A prospective study of procedural pain and analgesia in neonates. Arch Pediatr Adolesc Med. 2003;157(11):1058-1064. doi:10.1001/archpedi.157.11.1058
5. Selvanathan T, Zaki P, McLean MA, et al. Early-life exposure to analgesia and 18-month neurodevelopmental outcomes in very preterm infants. Pediatr Res. 2023;94(2):738-746. doi:10.1038/s41390-023-02536-y
6. Ferguson SA, Ward WL, Paule MG, Hall RW, Anand KJ. A pilot study of preemptive morphine analgesia in preterm neonates: effects on head circumference, social behavior, and response latencies in early childhood. Neurotoxicol Teratol. 2012;34(1):47-55. doi:10.1016/j.ntt.2011.10.008
7. McPherson C, Miller SP, El-Dib M, Massaro AN, Inder TE. The influence of pain, agitation, and their management on the immature brain. Pediatr Res. 2020;88(2):168-175. doi:10.1038/s41390-019-0744-6
8. Reissland N, Francis B, Mason J. Can healthy fetuses show facial expressions of "pain" or "distress"?. PLoS One. 2013;8(6):e65530. Published 2013 Jun 5. doi:10.1371/journal.pone.0065530
9. Sekulic S, Gebauer-Bukurov K, Cvijanovic M, et al. Appearance of fetal pain could be associated with maturation of the mesodiencephalic structures. J Pain Res. 2016;9:1031-1038. Published 2016 Nov 11. doi:10.2147/JPR.S117959
10. Pattinson D, Fitzgerald M. The neurobiology of infant pain: development of excitatory and inhibitory neurotransmission in the spinal dorsal horn. Reg Anesth Pain Med. 2004;29(1):36-44. doi:10.1016/j.rapm.2003.10.018
11. Lowery CL, Hardman MP, Manning N, Hall RW, Anand KJ, Clancy B. Neurodevelopmental changes of fetal pain [published correction appears in Semin Perinatol. 2009 Dec;33(6):410. Clancy, Barbara [added]]. Semin Perinatol. 2007;31(5):275-282. doi:10.1053/j.semperi.2007.07.004
12. Torsney C, Fitzgerald M. Spinal dorsal horn cell receptive field size is increased in adult rats following neonatal hindpaw skin injury. J Physiol. 2003;550(Pt 1):255-261. doi:10.1113/jphysiol.2003.043661
13. Ririe DG, Bremner LR, Fitzgerald M. Comparison of the immediate effects of surgical incision on dorsal horn neuronal receptive field size and responses during postnatal development. Anesthesiology. 2008;109(4):698-706. doi:10.1097/ALN.0b013e3181870a32
14. Walker SM, Tochiki KK, Fitzgerald M. Hindpaw incision in early life increases the hyperalgesic response to repeat surgical injury: critical period and dependence on initial afferent activity. Pain. 2009;147(1-3):99-106. doi:10.1016/j.pain.2009.08.017
15. Benzon HT, Strichartz GR, Gissen AJ, Shanks CA, Covino BG, Datta S. Developmental neurophysiology of mammalian peripheral nerves and age-related differential sensitivity to local anaesthetic. Br J Anaesth. 1988;61(6):754-760. doi:10.1093/bja/61.6.75417
16. Cristiani F, Henderson R, Lauber C, Boretsky K. Success of bedside ultrasound to identify puncture site for spinal anesthesia in neonates and infants. Reg Anesth Pain Med. Published online July 3, 2019. doi:10.1136/rapm-2019-100672
17. Coté CJ, Lerman J, Anderson BJ. A Practice of Anesthesia for Infants and Children. 6th ed. Elsevier; 2019.. 1192 p.
18. Benzon HT, Strichartz GR, Gissen AJ, Shanks CA, Covino BG, Datta S. Developmental neurophysiology of mammalian peripheral nerves and age-related differential sensitivity to local anaesthetic. Br J Anaesth. 1988;61(6):754-760. doi:10.1093/bja/61.6.754
19. Davidson AJ, Disma N, de Graaff JC, et al. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial [published correction appears in Lancet. 2016 Jan 16;387(10015):228. doi: 10.1016/S0140-6736(16)00054-4]. Lancet. 2016;387(10015):239-250. doi:10.1016/S0140-6736(15)00608-X
20. Mansfield SA, Woodroof J, Murphy AJ, Davidoff AM, Morgan KJ. Does epidural analgesia really enhance recovery in pediatric surgery patients?. Pediatr Surg Int. 2021;37(9):1201-1206. doi:10.1007/s00383-021-04897-z
21. Franz AM, Martin LD, Liston DE, Latham GJ, Richards MJ, Low DK. In Pursuit of an Opioid-Free Pediatric Ambulatory Surgery Center: A Quality Improvement Initiative. Anesth Analg. 2021;132(3):788-797. doi:10.1213/ANE.0000000000004774
22. Davidson AJ, Morton NS, Arnup SJ, et al. Apnea after Awake Regional and General Anesthesia in Infants: The General Anesthesia Compared to Spinal Anesthesia Study--Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial. Anesthesiology. 2015;123(1):38-54. doi:10.1097/ALN.0000000000000709
23. Bösenberg AT, Hadley GP, Wiersma R. Oesophageal atresia: caudo-thoracic epidural anaesthesia reduces the need for post-operative ventilatory support. Pediatric Surgery International. 1992;7(4):289-291. doi:https://doi.org/10.1007/bf00183983
24. Ecoffey C, Dubousset AM, Samii K. Lumbar and thoracic epidural anesthesia for urologic and upper abdominal surgery in infants and children. Anesthesiology. 1986;65(1):87-90. doi:10.1097/00000542-198607000-00017
25. Wilson GA, Brown JL, Crabbe DG, Hinton W, McHugh PJ, Stringer MD. Is epidural analgesia associated with an improved outcome following open Nissen fundoplication?. Paediatr Anaesth. 2001;11(1):65-70. doi:10.1046/j.1460-9592.2001.00597.x
26. Wolf AR. Effects of regional analgesia on stress responses to pediatric surgery. Paediatr Anaesth. 2012;22(1):19-24. doi:10.1111/j.1460-9592.2011.03714.x,
27. Snyder GL, Greenberg S. Effect of anaesthetic technique and other perioperative factors on cancer recurrence. Br J Anaesth. 2010;105(2):106-115. doi:10.1093/bja/aeq164
28. Hoehn T, Jetzek-Zader M, Blohm M, Mayatepek E. Early peristalsis following epidural analgesia during abdominal surgery in an extremely low birth weight infant. Paediatr Anaesth. 2007;17(2):176-179. doi:10.1111/j.1460-9592.2006.02038.x
29. Garcia Guerra G, Robertson CM, Alton GY, et al. Neurotoxicity of sedative and analgesia drugs in young infants with congenital heart disease: 4-year follow-up. Paediatr Anaesth. 2014;24(3):257-265. doi:10.1111/pan.12257
30. Davis PJ, Cladis FP. Smith’s Anesthesia for Infants and Children E-Book. Elsevier Health Sciences; 2016:1425.
31. Lerman J, Strong HA, LeDez KM, Swartz J, Rieder MJ, Burrows FA. Effects of age on the serum concentration of alpha 1-acid glycoprotein and the binding of lidocaine in pediatric patients. Clin Pharmacol Ther. 1989;46(2):219-225. doi:10.1038/clpt.1989.129
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