The Effect of Caudal Anesthesia Block on Perioperative Pain Control and Reduction of the Anesthetic Agent in Pediatric Infraumbilical Surgery: A Prospective Randomized Trial Study

Zeana Amer Gawe, Hasan Mohamed Isa, Muatasem Mohamed Almashaur, Fayza Haider, Khadija Almulla, Zeana Amer Gawe, Hasan Mohamed Isa, Muatasem Mohamed Almashaur, Fayza Haider, Khadija Almulla

Abstract

Background: Caudal epidural block (CEB) is a commonly performed neuraxial block to provide effective pain relief and analgesia in pediatric patients undergoing infraumbilical surgery.

Aims: This study aimed to compare the effectiveness of adding CEB to general anesthesia (GA) in terms of intra- and postoperative pain management.

Design: Prospective, randomized case-controlled trial study.

Setting: Operation theater, and postoperative recovery rooms at Salmaniya Medical Complex, Bahrain.

Materials and methods: A total of 74 patients aged 2 months to 6 years with American Society of Anesthesiologists physical status classification I were recruited over a 6-month period between December 2019 and May 2020. Patients were allocated into two groups (Group A, with CEB) or (Group B, without CEB). Both groups were compared based on hemodynamic stability, pain scores, level of sedation, analgesia need, and parental satisfaction.

Statistical analysis: Data were analyzed using SPSS program. Categorical and numerical variables of both the groups were compared.

Results: Patients with CEB had better hemodynamic stability during the surgical procedure based on heart rate (P = 0.039). Pain intensity scores were less in patients with CEB than those without (P < 0.001). Fentanyl consumption was lower in Group A compared to Group B at the end of surgery (P = 0.002). They were also ambulated earlier and discharged sooner than those without CEB. Parental satisfaction was 92.1% in Group A compared to 63.9% in Group B (P = 0.012).

Conclusions: Adding CEB to GA for intraoperative and perioperative pain control in pediatric patients undergoing infraumbilical surgery makes it more effective, safe, and with better parental satisfaction.

Keywords: Analgesic; caudal anesthesia; general anesthesia; pain management; pediatric; perioperative; sedation.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2022 Anesthesia: Essays and Researches.

Figures

Figure 1
Figure 1
Effect of caudal block versus noncaudal block anesthesia on pain intensity at 1 and 6 h, and the degree of sedation based on Ramsay Sedation Scale in children undergoing infraumbilical surgery under general anesthesia

References

    1. Lichtor JL, Mancini P. Ambulatory anesthesia. In: Barash PG, Cullen BF, editors. Clinical Anesthesia. 8th ed. Philadelphia: Wolters Kluwer Press; 2017. pp. 2115–8.
    1. Raux O, Dadue C, Carr J, Rochette A, Capdevila X. Paediatric caudal anaesthesia. Update Anaesth. 2010;26:32–36.
    1. Kao SC, Lin CS. Caudal epidural block: An updated review of anatomy and techniques. Biomed Res Int 2017. 2017 9217145.
    1. Ozen V, Yigit D. A comparison of the postoperative analgesic effectiveness of low dose caudal epidural block and US-guided dorsal penile nerve block with in-plane technique in circumcision. J Pediatr Urol. 2020;16:99–106.
    1. Banerjee A, Das B, Mukherjee D, Khanra M. A study of the effect of caudal epidural block on bispectral index targeted propofol requirement in children: A comparative study. J Indian Assoc Pediatr Surg. 2015;20:77–81.
    1. Nikooseresht M, Hashemi M, Mohajerani SA, Shahandeh F, Agah M. Ultrasound as a screening tool for performing caudal epidural injections. Iran J Radiol. 2014;11:e13262.
    1. Kim YH, Park HJ, Cho S, Moon DE. Assessment of factors affecting the difficulty of caudal epidural injections in adults using ultrasound. Pain Res Manag. 2014;19:275–9.
    1. Senoglu N, Senoglu M, Oksuz H, Gumusalan Y, Yuksel KZ, Zencirci B, et al. Landmarks of the sacral hiatus for caudal epidural block: An anatomical study. Br J Anaesth. 2005;95:692–5.
    1. Suresh S, Long J, Birmingham PK, De Oliveira GS., Jr 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;120:151–6.
    1. Park GY, Kwon DR, Cho HK. Anatomic differences in the sacral hiatus during caudal epidural injection using ultrasound guidance. J Ultrasound Med. 2015;34:2143–8.
    1. Kataria AP, Jarewal V, Kumar R, Kashyap A. Comparison of levobupivacaine and levobupivacaine with dexmedetomidine in infraumbilical surgeries under spinal anesthesia. Anesth Essays Res. 2018;12:251–5.
    1. Joo J, Kim J, Lee J. The prevalence of anatomical variations that can cause inadvertent dural puncture when performing caudal block in Koreans: A study using magnetic resonance imaging. Anaesthesia. 2010;65:23–6.
    1. Cesim I, Arzu AY, Firdevs O. Caudal block with general anesthesia for outpatient pediatric surgery procedures. J Anesth Criti Care Open Access. 2017;7:1–3.
    1. Shamim F, Ullah H, Khan FA. Postoperative pain assessment using four behavioral scales in Pakistani children undergoing elective surgery. Saudi J Anaesth. 2015;9:174–8.
    1. Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B. The Faces Pain Scale-Revised: Toward a common metric in pediatric pain measurement. Pain. 2001;93:173–83.
    1. Manchikanti L, Cash KA, Pampati V, McManus CD, Damron KS. Evaluation of fluoroscopically guided caudal epidural injections. Pain Physician. 2004;7:81–92.
    1. Ben-David B, Vaida S, Gaitini L. The influence of high spinal anesthesia on sensitivity to midazolam sedation. Anesth Analg. 1995;81:525–8.
    1. Walker SM, Yaksh TL. Neuraxial analgesia in neonates and infants: A review of clinical and preclinical strategies for the development of safety and efficacy data. Anesth Analg. 2012;115:638–62.
    1. Shin SK, Hong JY, Kim WO, Koo BN, Kim JE, Kil HK. Ultrasound evaluation of the sacral area and comparison of sacral interspinous and hiatal approach for caudal block in children. Anesthesiology. 2009;111:1135–40.
    1. Kim DW, Lee SJ, Choi EJ, Lee PB, Jo YH, Nahm FS. Morphologic diversities of sacral canal in children; three-dimensional computed tomographic study. Korean J Pain. 2014;27:253–9.
    1. Ponde V, Dave N, Puri K. Continuous caudal catheters in neonatal population: A focussed review. Int J Regional Anaesth. 2021;2 00-00. [Doi: 10.13107/ijra.2021.v02i02.040]
    1. Ebert TJ, Naze SA. Anesthesia drugs and adjuvants. In: Barash PG, Cullen BF, editors. Clinical Anesthesia. 8th ed. Philadelphia: Wolters Kluwer Press; 2017. pp. 1310–40.

Source: PubMed

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