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Background and Aims Small bowel atresia is a congenital condition requiring prompt surgical intervention. Effective pain management in neonatal surgery is critical yet challenging. Opioid use can delay spontaneous breathing and recovery of peristalsis in infants. This study aims to evaluate the efficacy and safety of peridural catheter anesthesia in a neonatal patient undergoing surgical treatment for small bowel atresia.

Methods A full-term newborn diagnosed with small bowel atresia and a perimembranous VSD with a significant left-to-right shunt was scheduled for surgical correction. A peridural catheter was placed at the caudal interspace under ultrasound navigation. General anesthesia was established with Propofol and Suxamethonium, and hemodynamics were maintained using Dopamine at 5 mcg/kg/min. After intubation, the catheter was inserted from the caudal space to the thoracic level under ultrasound guidance using a 20G Tuohy needle. Anesthesia was maintained with Sevoflurane and a continuous infusion of Ropivacaine 0.1% at 0.6 ml/h (0.2 mg/kg/h)

Results The peridural catheter provided adequate analgesia throughout the 5-hour surgical procedure. Hemodynamic parameters remained stable, with no significant intraoperative fluctuations in blood pressure or heart rate. The patient was extubated successfully in the OR and transferred to the NICU for further monitoring and care. Postoperatively, the newborn exhibited excellent pain control with no need for additional opioids, except NSAIDs. No immediate or delayed complications related to the peridural catheter were observed.

Conclusions The use of a peridural catheter in a neonatal patient undergoing surgery was effective and safe, facilitating excellent pain management and stable intraoperative conditions, contributing to a favorable surgical outcome.