Epidural anesthesia and analgesia in neonates and infants: Protocol for a scoping review.

Abstract

Surgery and anesthesia in neonates and infants are performed only when necessary due to their immature physiological systems and limited cardiorespiratory reserves, rendering them particularly susceptible to complications. Effective pain management in the context of major surgical procedures presents a considerable challenge. Untreated pain activates cellular and humoral pathways that are detrimental to recovery. Although opioids are effective analgesics, their use is associated with hypoventilation and may exacerbate the physiological apnea commonly observed in newborns. This can extend the requirement for positive pressure ventilation, increasing the risks of both immediate and long-term adverse outcomes. Epidural anesthesia and analgesia offer a promising alternative by providing effective pain relief while reducing opioid consumption, thus minimizing respiratory impairment and promoting more rapid recovery. This scoping review aims to map existing knowledge, to shed light on knowledge gaps, and lay the groundwork for further research. This review will follow the JBI methodology and adhere to the PRISMA guidelines for Scoping Reviews. A comprehensive search will be conducted across peer-reviewed databases, published literature, online resources, ongoing studies, and gray literature to identify all available evidence on epidural anesthesia and analgesia in thoracic and abdominal surgeries in neonates and infants. The findings from the included studies will be synthesized narratively and presented with tables and figures to ensure a clear and structured overview. This scoping review aims to summarize the current evidence on epidural anesthesia and analgesia in neonates and infants. It will highlight well-researched areas, identify gaps in the literature, and outline existing knowledge and unmet research needs in this field.