Uso de catéteres caudales para analgesia postoperatoria en lactantes y neonatos llevados a cirugía abdominal: Una revisión narrativa
Publicado
jul 31, 2024
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Angelica Paola Fajardo
https://orcid.org/0000-0003-2166-9048
Gabriel Salim Rezk Schuler
https://orcid.org/0000-0001-6499-9325
Silvia Clavijo Vega
https://orcid.org/0000-0001-9827-4322
https://orcid.org/0000-0003-2166-9048
Gabriel Salim Rezk Schuler
https://orcid.org/0000-0001-6499-9325
Silvia Clavijo Vega
https://orcid.org/0000-0001-9827-4322
##plugins.themes.bootstrap3.article.details##
Resumen
Introducción: El manejo del dolor en menores de un año implica desafíos por la inmadurez fisiológica, limitaciones éticas y dificultades en la medición del dolor. Se emplean escalas como PiPP y FLACC para ello. Aunque la analgesia multimodal, especialmente la regional, es crucial, las dosis se restringen dado el peso y la inmadurez fisiológica.
Métodos: Se efectuó una búsqueda de literatura en inglés y español entre 2013 y 2023, enfocándose en revisiones, metaanálisis y ensayos clínicos sobre analgesia caudal en neonatos e infantes menores.
Resultados: Numerosos estudios respaldan la eficacia y seguridad de la analgesia caudal en menores de un año sometidos a cirugías, destacando beneficios como menor tiempo de extubación, bajos puntajes de dolor y reducción de complicaciones. Aunque se observan tasas de complicaciones, estas no parecen ser una barrera significativa para el uso de bloqueos caudales en esta población.
Discusión: La analgesia caudal en neonatos e infantes es crucial debido a su inmadurez fisiológica. A pesar de beneficios como extubación temprana y reducción de complicaciones de analgesia intravenosa, la heterogeneidad en estudios y la falta de estándares dificultan las recomendaciones. A pesar de las complicaciones, se destaca la necesidad de entrenamiento especializado en la colocación de catéteres caudales en esta población.
Keywords
Lactantes, Neonatos, Dolor, Analgesia caudal, Cateter caudalneonates, infants, pain, caudal analgesia, caudal catheter
References
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2. Larsson BA, Lonnqvist PA, Olsson GL. Plasma concentrations of bupivacaine in neonates after continuous epidural infusion. Anesth Analg. 1997 Mar;84(3):501-5. https://doi.org/10.1097/00000539-199703000-00006
3. Peutrell JM, Holder K, Gregory M. Plasma bupivacaine concentrations associated with continuous extradural infusions in babies. Br J Anaesth. 1997 Feb;78(2):160-2. https://doi.org/10.1093/bja/78.2.160
4. Walker SM. Neonatal pain. Pediatr Anesth. 2014 Jan 13;24(1):39-48. https://doi.org/10.1111/pan.12211
5. Allegaert K, van den Anker JN. Perinatal and neonatal use of paracetamol for pain relief. Semin Fetal Neonatal Med. 2017 Oct;22(5):308-13. https://doi.org/10.1016/j.siny.2017.07.006
6. Maitra S, Baidya DK, Khanna P, Ray BR, Panda SS, Bajpai M. Acute perioperative pain in neonates: an evidence-based review of neurophysiology and management. Acta Anaesthesiologica Taiwanica. 2014 Mar;52(1):30-7. https://doi.org/10.1016/j.aat.2014.02.001
7. McCloskey JJ, Haun SE, Deshpande JK. Bupivacaine toxicity secondary to continuous caudal epidural infusion in children. Anesth Analg. 1992 Aug;75(2):287-90. https://doi.org/10.1213/00000539-199208000-00025
8. Jöhr M. Regional anaesthesia in neonates, infants and children. Eur J Anaesthesiol. 2015 May;32(5):289-97. https://doi.org/10.1097/EJA.0000000000000257
9. Vidal MA, Calderón E, Martínez E, Gonzálvez A, Torres LM. Dolor en neonatos. Rev Soc Esp Dolor. 2005 Mar;12(2).
10. Manworren RCB, Stinson J. Pediatric pain measurement, assessment, and evaluation. Semin Pediatr Neurol. 2016 Aug;23(3):189-200.
11. Maxwell LG, Fraga M V., Malavolta CP. Assessment of pain in the newborn. Clin Perinatol. 2019 Dec;46(4):693-707.
12. Morales OL, Gómez MA. Manual para el manejo de la urgencia dolorosa: gestión asistencial integral-Hospital Universitario San Ignacio. Bogotá: Almera SGI; 2020. p. 1-19.
13. O’Donnell FT, Rosen KR. Pediatric pain management: a review. Mo Med. 2014;111(3):231-7.
14. Solak M, Ulusoy H, Sarihan H. Effects of caudal block on cortisol and prolactin responses to postoperative pain in children. Eur J Pediatr Surg. 2000 Aug 25;10(04):219-23. https://doi.org/10.1055/s-2008-1072354
15. Jones LJ, Craven PD, Lakkundi A, Foster JP, Badawi N. Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy. Cochrane Database Syst Rev. 2015(6). https://doi.org/10.1002/14651858.CD003669.pub2
16. Kost-Byerly S, Jackson E V., Yaster M, Kozlowski LJ, Mathews RI, Gearhart JP. Perioperative anesthetic and analgesic management of newborn bladder exstrophy repair. J Pediatr Urol. 2008 Aug;4(4):280-5. https://doi.org/10.1016/j.jpurol.2008.03.006:contentReference[oaicite:0]{index=0}
17. Mcneely J, Farber N, Rusy L, Hoffman G. Epidural analgesia improves outcome following pediatric fundoplicationA retrospective analysis. Reg Anesth Pain Med. 1997 Jan;22(1):16-23.
18. Bouza H. The impact of pain in the immature brain. J Matern Fetal Neonatal Med. 2009 Sep 27;22(9):722-32. https://doi.org/10.3109/14767050902926962
19. Walker SM, Yaksh TL. Neuraxial analgesia in neonates and infants. Anesth Analg. 2012 Sep;115(3):638-62.
20. Bösenberg AT, Hadley GP, Wiersma R. Oesophageal atresia: caudo-thoracic epidural anaesthesia reduces the need for post-operative ventilatory support. Pediatr Surg Int. 1992 Jun;7(4):289-91. https://doi.org/10.1007/BF00183983
21. Grunau RE, Holsti L, Peters JWB. Long-term consequences of pain in human neonates. Semin Fetal Neonatal Med. 2006 Aug;11(4):268-75.
22. Whitaker EE, Williams RK. Epidural and spinal anesthesia for newborn surgery. Clin Perinatol. 2019 Dec;46(4):731-43.
23. Cruz J. Bupivacaina al 0.0625% y clonidina en el boqueo caudal para cirugía ambulatoria en niños. Ciudad de México: Universidad Nacional Autónoma de México; 2005.
24. Singaravelu Ramesh A, Boretsky K. Local anesthetic systemic toxicity in children: a review of recent case reports and current literature. Reg Anesth Pain Med. 2021 Oct;46(10):909-14. https://doi.org/10.1136/rapm-2021-102529
25. Irigoyen-Castillo AJ, Moyao-García D, Ramírez-Mora JC. Minimización de dosis de bupivacaína y ropivacaína para analgesia epidural en infusión. Rev Mex Anestesiol. 2007;30(supl 1):S326-8.
26. Agarwal R, Gutlove DP, Lockhart CH. Seizures occurring in pediatric patients receiving continuous infusion of bupivacaine. Anesth Analg. 1992 Aug;75(2):284-6.
27. Flandin-Bléty C, Barrier G. Accidents following extradural analgesia in children. The results of a retrospective study. Pediatr Anesth. 1995 Jan;5(1):41-6.
28. Giaufre E, Dalens B, Gombert A. Epidemiology and morbidity of regional anesthesia in children. Anesth Analg. 1996 Nov;83(5):904-12.
29. Llewellyn N, Moriarty A. The National Pediatric Epidural Audit. Pediatr Anesth. 2007 Jun 7;17(6):520-33.
30. Meunier JF, Goujard E, Dubousset AM, Samii K, Xavier Mazoit J. Pharmacokinetics of bupivacaine after continuous epidural infusion in infants with and without biliary atresia. Anesthesiology. 2001 Jul 1;95(1):87-95. https://doi.org/10.1097/00000542-200107000-00018
31. Richter O, Klein K, Abel J, Ohnesorge FK, Wüst HJ, Thiessen FM. The kinetics of bupivacaine (Carbostesin) plasma concentrations during epidural anesthesia following intraoperative bolus injection and subsequent continuous infusion. Int J Clin Pharmacol. 1984 Nov;22(11):611-7.
32. Luz G, Innerhofer P, Bachmann B, Frischhut B, Menardi G, Benzer A. Bupivacaine plasma concentrations during continuous epidural anesthesia in infants and children. Anesth Analg. 1996 Feb;82(2):231-4. https://doi.org/10.1097/00000539-199602000-00002
33. Luz G, Wieser C, Innerhofer P, Frischhut B, Ulmer H, Benzer A. Free and total bupivacaine plasma concentrations after continuous epidural anaesthesia in infants and children. Paediatr Anaesth. 1998;8(6):473-8. https://doi.org/10.1046/j.1460-9592.1998.00285.x
34. Nagappa S, Kalappa S, Vijayakumar H, Nethra H. Comparison of the effectiveness of intravenous fentanyl versus caudal epidural in neonates undergoing tracheoesophageal fistula surgeries. Saudi J Anaesth. 2022;16(2):182.
35. Okonkwo I, Bendon AA, Cervellione RM, Vashisht R. Continuous caudal epidural analgesia and early feeding in delayed bladder exstrophy repair: a nine-year experience. J Pediatr Urol. 2019 Feb;15(1):76.e1-76.e8.
36. Ho AMH, Torbicki E, Winthrop AL, Kolar M, Zalan JE, MacLean G, et al. Caudal catheter placement for repeated epidural morphine doses after neonatal upper abdominal surgery. Anaesth Intensive Care. 2022 Mar 16;50(1-2):141-5.
37. Sato M, Iida T, Kikuchi C, Sasakawa T, Kunisawa T. Comparison of caudal ropivacaine‐morphine and paravertebral catheter for major upper abdominal surgery in infants. Pediatric Anesthesia. 2017 May 8;27(5):524-30.
38. Solanki N, Engineer S, Vecham P. Comparison of epidural versus systemic analgesia for major surgeries in neonates and infants. J Clin Neonatol. 2017;6(1):23.
39. Ozer-Cinar AS, Isil CT, Hekimoglu-Sahin S, Paksoy İ. Caudal ropivacaine and bupivacaine for postoperative analgesia in infants undergoing lower abdominal surgery. Pak J Med Sci. 1969 Dec 31;31(4). https://doi.org/10.12669/pjms.314.5432
40. Ross EL, Reiter PD, Murphy ME, Bielsky AR. Evaluation of prolonged epidural chloroprocaine for postoperative analgesia in infants. J Clin Anesth. 2015 Sep;27(6):463-9. https://doi.org/10.1016/j.jclinane.2015.05.022
41. Praveen P, Remadevi R, Pratheeba N. Caudal epidural analgesia in pediatric patients: comparison of 0.25% levobupivacaine and 0.25% ropivacaine in terms of motor blockade and postoperative analgesia. Anesth Essays Res. 2017;11(1):223. https://doi.org/10.4103/0259-1162.200231
42. Waurick K, Sauerland C, Goeters C. Dexmedetomidine sedation combined with caudal anesthesia for lower abdominal and extremity surgery in ex‐preterm and full‐term infants. Pediatr Anesth. 2017 Jun 2;27(6):637-42.
43. Álvarez García N. Anestesia caudal en neonatos y lactantes como procedimiento anestésico en cirugía abdominal y del canal inguinal: nuestra experiencia. Cir Pediátr. 2019;32(4):181-4.
44. Kasat N, Dave N, Shah H, Mahajan S. Correção de gastrosquise sob anestesia caudal: uma série de três casos. Rev Bras Anestesiol. 2017 May-Jun;67(3):326-8 [Portuguese]. https://doi.org/10.1016/j.bjan.2016.07.004
45. Veneziano G, Iliev P, Tripi J, Martin D, Aldrink J, Bhalla T, et al. Continuous chloroprocaine infusion for thoracic and caudal epidurals as a postoperative analgesia modality in neonates, infants, and children. Pediatr Anesthsia. 2016 Jan 4;26(1):84-91.
46. Gibbs A, Kim SS, Heydinger G, Veneziano G, Tobias J. Postoperative analgesia in neonates and infants using epidural chloroprocaine and clonidine. J Pain Res. 2020 Oct;30;13:2749-55. https://doi.org/10.2147/JPR.S281484
47. Wong GK, Arab AA, Chew SC, Naser B, Crawford MW. Major complications related to epidural analgesia in children: a 15-year audit of 3,152 epidurals. Can J Anaesth. 2013 Apr;60(4):355-63. https://doi.org/10.1007/s12630-012-9877-3
48. Suresh S, Long J, Birmingham PK, De Oliveira GS. Are caudal blocks for pain control safe in children? An analysis of 18,650 caudal blocks from the Pediatric Regional Anesthesia Network (PRAN) Database. Anesth Analg. 2015 Jan;120(1):151-6.
49. Broadman L, Holt R. The evidence-based safety of pediatric regional anesthesia and complications. En: Finucane B, editor. Complications of regional anesthesia. 2.ª ed. New York: Springer; 2007. p. 224-41.
50. Farid IS, Kendrick EJ, Adamczyk MJ, Lukas NR, Massanyi EZ. Perioperative analgesic management of newborn bladder exstrophy repair using a directly placed tunneled epidural catheter with 0.1% ropivacaine. A A Case Rep. 2015 Oct;5(7):112-4. https://doi.org/10.1213/XAA.0000000000000191
51. Maitra S, Baidya DK, Pawar DK, Arora MK, Khanna P. Epidural anesthesia and analgesia in the neonate: a review of current evidences. J Anesth. 2014 Oct 13;28(5):768-79.
52. Maitra S, Baidya DK, Pawar DK, Arora MK, Khanna P. Epidural anesthesia and analgesia in the neonate: a review of current evidences. J Anesth. 2014 Oct 13;28(5):768-79.
53. Inouye BM, Massanyi EZ, Di Carlo H, Shah BB, Gearhart JP. Modern management of bladder exstrophy repair. Curr Urol Rep. 2013 Aug 19;14(4):359-65.
54. Wiegele M, Marhofer P, Lönnqvist PA. Caudal epidural blocks in paediatric patients: a review and practical considerations. Br J Anaesth. 2019 Apr;122(4):509-17.
55. Crellin DJ, Harrison D, Santamaria N, Babl FE. Systematic review of the face, legs, activity, cry and consolability scale for assessing pain in infants and children. Pain. 2015 Nov;156(11):2132-51. https://doi.org/10.1097/j.pain.0000000000000305
2. Larsson BA, Lonnqvist PA, Olsson GL. Plasma concentrations of bupivacaine in neonates after continuous epidural infusion. Anesth Analg. 1997 Mar;84(3):501-5. https://doi.org/10.1097/00000539-199703000-00006
3. Peutrell JM, Holder K, Gregory M. Plasma bupivacaine concentrations associated with continuous extradural infusions in babies. Br J Anaesth. 1997 Feb;78(2):160-2. https://doi.org/10.1093/bja/78.2.160
4. Walker SM. Neonatal pain. Pediatr Anesth. 2014 Jan 13;24(1):39-48. https://doi.org/10.1111/pan.12211
5. Allegaert K, van den Anker JN. Perinatal and neonatal use of paracetamol for pain relief. Semin Fetal Neonatal Med. 2017 Oct;22(5):308-13. https://doi.org/10.1016/j.siny.2017.07.006
6. Maitra S, Baidya DK, Khanna P, Ray BR, Panda SS, Bajpai M. Acute perioperative pain in neonates: an evidence-based review of neurophysiology and management. Acta Anaesthesiologica Taiwanica. 2014 Mar;52(1):30-7. https://doi.org/10.1016/j.aat.2014.02.001
7. McCloskey JJ, Haun SE, Deshpande JK. Bupivacaine toxicity secondary to continuous caudal epidural infusion in children. Anesth Analg. 1992 Aug;75(2):287-90. https://doi.org/10.1213/00000539-199208000-00025
8. Jöhr M. Regional anaesthesia in neonates, infants and children. Eur J Anaesthesiol. 2015 May;32(5):289-97. https://doi.org/10.1097/EJA.0000000000000257
9. Vidal MA, Calderón E, Martínez E, Gonzálvez A, Torres LM. Dolor en neonatos. Rev Soc Esp Dolor. 2005 Mar;12(2).
10. Manworren RCB, Stinson J. Pediatric pain measurement, assessment, and evaluation. Semin Pediatr Neurol. 2016 Aug;23(3):189-200.
11. Maxwell LG, Fraga M V., Malavolta CP. Assessment of pain in the newborn. Clin Perinatol. 2019 Dec;46(4):693-707.
12. Morales OL, Gómez MA. Manual para el manejo de la urgencia dolorosa: gestión asistencial integral-Hospital Universitario San Ignacio. Bogotá: Almera SGI; 2020. p. 1-19.
13. O’Donnell FT, Rosen KR. Pediatric pain management: a review. Mo Med. 2014;111(3):231-7.
14. Solak M, Ulusoy H, Sarihan H. Effects of caudal block on cortisol and prolactin responses to postoperative pain in children. Eur J Pediatr Surg. 2000 Aug 25;10(04):219-23. https://doi.org/10.1055/s-2008-1072354
15. Jones LJ, Craven PD, Lakkundi A, Foster JP, Badawi N. Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy. Cochrane Database Syst Rev. 2015(6). https://doi.org/10.1002/14651858.CD003669.pub2
16. Kost-Byerly S, Jackson E V., Yaster M, Kozlowski LJ, Mathews RI, Gearhart JP. Perioperative anesthetic and analgesic management of newborn bladder exstrophy repair. J Pediatr Urol. 2008 Aug;4(4):280-5. https://doi.org/10.1016/j.jpurol.2008.03.006:contentReference[oaicite:0]{index=0}
17. Mcneely J, Farber N, Rusy L, Hoffman G. Epidural analgesia improves outcome following pediatric fundoplicationA retrospective analysis. Reg Anesth Pain Med. 1997 Jan;22(1):16-23.
18. Bouza H. The impact of pain in the immature brain. J Matern Fetal Neonatal Med. 2009 Sep 27;22(9):722-32. https://doi.org/10.3109/14767050902926962
19. Walker SM, Yaksh TL. Neuraxial analgesia in neonates and infants. Anesth Analg. 2012 Sep;115(3):638-62.
20. Bösenberg AT, Hadley GP, Wiersma R. Oesophageal atresia: caudo-thoracic epidural anaesthesia reduces the need for post-operative ventilatory support. Pediatr Surg Int. 1992 Jun;7(4):289-91. https://doi.org/10.1007/BF00183983
21. Grunau RE, Holsti L, Peters JWB. Long-term consequences of pain in human neonates. Semin Fetal Neonatal Med. 2006 Aug;11(4):268-75.
22. Whitaker EE, Williams RK. Epidural and spinal anesthesia for newborn surgery. Clin Perinatol. 2019 Dec;46(4):731-43.
23. Cruz J. Bupivacaina al 0.0625% y clonidina en el boqueo caudal para cirugía ambulatoria en niños. Ciudad de México: Universidad Nacional Autónoma de México; 2005.
24. Singaravelu Ramesh A, Boretsky K. Local anesthetic systemic toxicity in children: a review of recent case reports and current literature. Reg Anesth Pain Med. 2021 Oct;46(10):909-14. https://doi.org/10.1136/rapm-2021-102529
25. Irigoyen-Castillo AJ, Moyao-García D, Ramírez-Mora JC. Minimización de dosis de bupivacaína y ropivacaína para analgesia epidural en infusión. Rev Mex Anestesiol. 2007;30(supl 1):S326-8.
26. Agarwal R, Gutlove DP, Lockhart CH. Seizures occurring in pediatric patients receiving continuous infusion of bupivacaine. Anesth Analg. 1992 Aug;75(2):284-6.
27. Flandin-Bléty C, Barrier G. Accidents following extradural analgesia in children. The results of a retrospective study. Pediatr Anesth. 1995 Jan;5(1):41-6.
28. Giaufre E, Dalens B, Gombert A. Epidemiology and morbidity of regional anesthesia in children. Anesth Analg. 1996 Nov;83(5):904-12.
29. Llewellyn N, Moriarty A. The National Pediatric Epidural Audit. Pediatr Anesth. 2007 Jun 7;17(6):520-33.
30. Meunier JF, Goujard E, Dubousset AM, Samii K, Xavier Mazoit J. Pharmacokinetics of bupivacaine after continuous epidural infusion in infants with and without biliary atresia. Anesthesiology. 2001 Jul 1;95(1):87-95. https://doi.org/10.1097/00000542-200107000-00018
31. Richter O, Klein K, Abel J, Ohnesorge FK, Wüst HJ, Thiessen FM. The kinetics of bupivacaine (Carbostesin) plasma concentrations during epidural anesthesia following intraoperative bolus injection and subsequent continuous infusion. Int J Clin Pharmacol. 1984 Nov;22(11):611-7.
32. Luz G, Innerhofer P, Bachmann B, Frischhut B, Menardi G, Benzer A. Bupivacaine plasma concentrations during continuous epidural anesthesia in infants and children. Anesth Analg. 1996 Feb;82(2):231-4. https://doi.org/10.1097/00000539-199602000-00002
33. Luz G, Wieser C, Innerhofer P, Frischhut B, Ulmer H, Benzer A. Free and total bupivacaine plasma concentrations after continuous epidural anaesthesia in infants and children. Paediatr Anaesth. 1998;8(6):473-8. https://doi.org/10.1046/j.1460-9592.1998.00285.x
34. Nagappa S, Kalappa S, Vijayakumar H, Nethra H. Comparison of the effectiveness of intravenous fentanyl versus caudal epidural in neonates undergoing tracheoesophageal fistula surgeries. Saudi J Anaesth. 2022;16(2):182.
35. Okonkwo I, Bendon AA, Cervellione RM, Vashisht R. Continuous caudal epidural analgesia and early feeding in delayed bladder exstrophy repair: a nine-year experience. J Pediatr Urol. 2019 Feb;15(1):76.e1-76.e8.
36. Ho AMH, Torbicki E, Winthrop AL, Kolar M, Zalan JE, MacLean G, et al. Caudal catheter placement for repeated epidural morphine doses after neonatal upper abdominal surgery. Anaesth Intensive Care. 2022 Mar 16;50(1-2):141-5.
37. Sato M, Iida T, Kikuchi C, Sasakawa T, Kunisawa T. Comparison of caudal ropivacaine‐morphine and paravertebral catheter for major upper abdominal surgery in infants. Pediatric Anesthesia. 2017 May 8;27(5):524-30.
38. Solanki N, Engineer S, Vecham P. Comparison of epidural versus systemic analgesia for major surgeries in neonates and infants. J Clin Neonatol. 2017;6(1):23.
39. Ozer-Cinar AS, Isil CT, Hekimoglu-Sahin S, Paksoy İ. Caudal ropivacaine and bupivacaine for postoperative analgesia in infants undergoing lower abdominal surgery. Pak J Med Sci. 1969 Dec 31;31(4). https://doi.org/10.12669/pjms.314.5432
40. Ross EL, Reiter PD, Murphy ME, Bielsky AR. Evaluation of prolonged epidural chloroprocaine for postoperative analgesia in infants. J Clin Anesth. 2015 Sep;27(6):463-9. https://doi.org/10.1016/j.jclinane.2015.05.022
41. Praveen P, Remadevi R, Pratheeba N. Caudal epidural analgesia in pediatric patients: comparison of 0.25% levobupivacaine and 0.25% ropivacaine in terms of motor blockade and postoperative analgesia. Anesth Essays Res. 2017;11(1):223. https://doi.org/10.4103/0259-1162.200231
42. Waurick K, Sauerland C, Goeters C. Dexmedetomidine sedation combined with caudal anesthesia for lower abdominal and extremity surgery in ex‐preterm and full‐term infants. Pediatr Anesth. 2017 Jun 2;27(6):637-42.
43. Álvarez García N. Anestesia caudal en neonatos y lactantes como procedimiento anestésico en cirugía abdominal y del canal inguinal: nuestra experiencia. Cir Pediátr. 2019;32(4):181-4.
44. Kasat N, Dave N, Shah H, Mahajan S. Correção de gastrosquise sob anestesia caudal: uma série de três casos. Rev Bras Anestesiol. 2017 May-Jun;67(3):326-8 [Portuguese]. https://doi.org/10.1016/j.bjan.2016.07.004
45. Veneziano G, Iliev P, Tripi J, Martin D, Aldrink J, Bhalla T, et al. Continuous chloroprocaine infusion for thoracic and caudal epidurals as a postoperative analgesia modality in neonates, infants, and children. Pediatr Anesthsia. 2016 Jan 4;26(1):84-91.
46. Gibbs A, Kim SS, Heydinger G, Veneziano G, Tobias J. Postoperative analgesia in neonates and infants using epidural chloroprocaine and clonidine. J Pain Res. 2020 Oct;30;13:2749-55. https://doi.org/10.2147/JPR.S281484
47. Wong GK, Arab AA, Chew SC, Naser B, Crawford MW. Major complications related to epidural analgesia in children: a 15-year audit of 3,152 epidurals. Can J Anaesth. 2013 Apr;60(4):355-63. https://doi.org/10.1007/s12630-012-9877-3
48. Suresh S, Long J, Birmingham PK, De Oliveira GS. Are caudal blocks for pain control safe in children? An analysis of 18,650 caudal blocks from the Pediatric Regional Anesthesia Network (PRAN) Database. Anesth Analg. 2015 Jan;120(1):151-6.
49. Broadman L, Holt R. The evidence-based safety of pediatric regional anesthesia and complications. En: Finucane B, editor. Complications of regional anesthesia. 2.ª ed. New York: Springer; 2007. p. 224-41.
50. Farid IS, Kendrick EJ, Adamczyk MJ, Lukas NR, Massanyi EZ. Perioperative analgesic management of newborn bladder exstrophy repair using a directly placed tunneled epidural catheter with 0.1% ropivacaine. A A Case Rep. 2015 Oct;5(7):112-4. https://doi.org/10.1213/XAA.0000000000000191
51. Maitra S, Baidya DK, Pawar DK, Arora MK, Khanna P. Epidural anesthesia and analgesia in the neonate: a review of current evidences. J Anesth. 2014 Oct 13;28(5):768-79.
52. Maitra S, Baidya DK, Pawar DK, Arora MK, Khanna P. Epidural anesthesia and analgesia in the neonate: a review of current evidences. J Anesth. 2014 Oct 13;28(5):768-79.
53. Inouye BM, Massanyi EZ, Di Carlo H, Shah BB, Gearhart JP. Modern management of bladder exstrophy repair. Curr Urol Rep. 2013 Aug 19;14(4):359-65.
54. Wiegele M, Marhofer P, Lönnqvist PA. Caudal epidural blocks in paediatric patients: a review and practical considerations. Br J Anaesth. 2019 Apr;122(4):509-17.
55. Crellin DJ, Harrison D, Santamaria N, Babl FE. Systematic review of the face, legs, activity, cry and consolability scale for assessing pain in infants and children. Pain. 2015 Nov;156(11):2132-51. https://doi.org/10.1097/j.pain.0000000000000305
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