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. 2023 Sep 28;38(5):e547.
doi: 10.5001/omj.2023.98. eCollection 2023 Sep.

Comparing Opioid with Opioid-free Anesthesia Technique in Neonates Undergoing Tracheoesophageal Fistula Repair

Maria Paul  1 , Charu Bamba  1 , V Vinay  2 , Bhavya Krishna  1 ; Bharani Kumar B.1
Affiliations

Comparing Opioid with Opioid-free Anesthesia Technique in Neonates Undergoing Tracheoesophageal Fistula Repair

Maria Paul et al. Oman Med J. .

Abstract

Objectives: Tracheoesophageal fistula (TEF) is a congenital disorder that presents as a surgical emergency in neonates. In regions where neonatal intensive care unit facilities and resources are inadequate and skilled personnel are scarce, not extubating neonates on table, contributes to mortality. Our aim was to assess and compare the on-table extubation rate, extubation time, and postoperative pain scores between opioid and opioid-free anesthesia techniques in neonates undergoing surgical repair of TEF.

Methods: We conducted a prospective, single-blind, randomized trial over 18 months between January 2021 and June 2022 in Safdarjung Hospital, New Delhi on 60 full-term neonates scheduled for TEF surgeries randomly allocated to two groups according to the mode of analgesia administered. Group O were given fentanyl injection 1 µg/kg intravenous (IV) loading dose with IV injection. acetaminophen at 7.5 mg/kg and top-up of 0.25 µg/kg fentanyl IV si opus sit. Group NO were given pre-surgical local infiltration and intercostal block with 0.25% and 0.5% bupivacaine, respectively, with IV acetaminophen at 7.5 mg/kg.

Results: Mean age in days, gender distribution, and weight in both groups were statistically comparable. The difference in the number of neonates extubated on table was statistically significant (p =0.002) in group NO compared to group O. Lower mean extubation time was seen in group NO (9.0 min 40.0 secs±3.0 min 3.0 secs) compared to group O (16.0 min 45.0 secs±8.0 min 5.0 secs) (p < 0.001). There was a statistically significant (p =0.010) lower Neonatal Infant Pain Scale score in group NO with mean and SD as 1.8±0.8 compared with group O, 2.5±1.1 at 90 min.

Conclusions: In neonates undergoing TEF repair, opioid-free anesthesia is a safe and effective method, providing a better extubation rate, faster time to extubation, and better postoperative pain control.

Keywords: Airway Extubation; Analgesics, Opioid; Fentanyl; Infant, Newborn; Tracheoesophageal Fistula.

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Figures

Figure 1
Figure 1
Flow chart describing the study method.
Figure 2
Figure 2
Surgeon administering intercostal nerve block with bupivacaine.
Figure 3
Figure 3
Comparing extubation time in group O versus group NO.
Figure 4
Figure 4
Neonatal Infant Pain Scale (NIPS) in group O versus group NO.
See this image and copyright information in PMC

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