Caudal block with 3 mg/Kg Bupivacaine for intraabdominal surgery in pediatric patients: a randomized study

Open access

Abstract

Background: Caudal block with the use of an adequate dose of bupivacaine, and combined with a general anesthesia (GA) provides intra-operative anesthesia and postoperative analgesia. No study has examined the use of 3 mg/Kg bupivacaine for intra-abdominal surgery in pediatric patients in clinical practice.

Objective: Compare the effectiveness of three mg/Kg bupivacaine administered as 1.2 mL/Kg 0.25% bupivacaine and 1.5 mL/Kg 0.2% bupivacaine for caudal block in pediatric patients undergoing intra-abdominal surgery.

Methods: In a randomized, double-blinded clinical trial, patients (age: 6 months -7 years) were randomly assigned into one of two groups (n= 40) to receive a caudal block with either 1.2 mL/Kg 0.25% bupivacaine (group A) or 1.5 mL/Kg 0.2% bupivacaine (group B), with morphine 50 μg/Kg. The effectiveness of intra-operative anesthesia, complications, and requirements for post-operative analgesia were evaluated.

Results: Data were available for 74 pediatric patients. There were no significant differences between the two groups in baseline characteristics. Intra-operatively, the numbers of patients who required a rescue analgesic were comparable between the groups (67% in group A and 63% in group B). The numbers of patients who required a muscle relaxant were also comparable between groups (49% in group A and 57% in group B). The time from discontinuation of the volatile anesthetic to extubation was significantly shorter in group B (9.5±1.1 minutes) than group A (14.3±0.9 minutes), p < 0.01. The time from initial caudal block to the first analgesic required in the recovery room was significantly longer in group B (202±45 minutes) than in group A (149±27 minutes). The time from the caudal block to the first analgesic required in the ward was significantly longer in group B (10.4±3.1 hours) than in group A (8.2±2.0 hours). Overall fentanyl requirements were comparable between groups, 52.5±2.0 μg in group A and 49.5±3.0 μg in group B.

Conclusion: Caudal block by either 1.2 mL/Kg 0.25% bupivacaine plus morphine 50 μg/Kg or 1.5 mL/Kg 0.2% bupivacaine plus morphine 50 μg/Kg provided effectively equivalent intra-operative analgesia and surgical relaxation. However, a caudal block with 1.5 mL/Kg 0.2% bupivacaine plus morphine 50 μg/Kg provided superior prolonged analgesic advantages compared with 1.2 mL/Kg 0.25% bupivacaine plus morphine 50 μg/Kg in pediatric patients undergoing intra-abdominal surgery.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Willis RJ. Caudal epidural blockade. In: Cousins MJ Bridenbaugh PO eds. Neural blockade in clinical anesthesia and management of pain. 3rd ed. Philadelphia:Lippincott-Raven 1998. p. 323-42.

  • 2. Verghese ST Hannallah RS Rice LJ Belman AB Patel KM. Caudal anesthesia in children: effect of volume versus concentration of bupivacaine on blocking spermatic cord traction response during orchidopexy. Anesth Analg. 2002; 95:1219-23.

  • 3. McGown RG. Caudal analgesia in children. Anaesthesia. 1982; 37: 806 -18.

  • 4. Dalens BJ. Regional anesthetic techniques. In: Bissonette B Dalens BJ eds. Pediatric anesthesia: principles and practice. New York:McGraw-Hill Companies 2002. p. 528 -75.

  • 5. Gunter JB Watcha M Forestner J Hirshberg G Dunn CM Connor M et al. Caudal epidural anesthesia in conscious premature and high-risk infants. J Paediatr Surge. 1991; 26: 9-14.

  • 6. Wheeler M Suresh S. Practical pediatric regional anesthesia. In: Mason LJ Kim MS eds. Anesthesiology clinics of North America: new concepts and techniques in pediatric anesthesia. Philadelphia: WB Saunders 2002. Vol.20 p. 83-113.

  • 7. Moyao-Garcia D Garza-Leyva M Velazquez-Armenta EY Nava-Ocampo AA. Caudal block with 4 mg/kg (1.6 ml/kg) of bupivacaine 0.25% in children undergoing surgical correction of congenital pyloric stenosis. Paediatr Anaesth. 2002 12: 404-10.

  • 8. Ansermino M Basu R Vandebeck C Montgomery C. Nonopioid additives to local anaesthetics for caudal blockade in children: a systematic review. Paediatr Anaesth. 2003; 13: 561-73.

  • 9. Cairns C. Caudal anaesthesia in neonates and infants. Anaesthesia. 1980; 35: 806-18.

  • 10. Yaster M Maxwell LG. Pediatric regional anesthesia. Anesthesiology. 1989; 70: 324-38.

  • 11. Breschan C Hellstrand E Likar R Linnquist PA. Early signs of toxicity and ‘subtoxic’ conditions in infant monitoring. Bupivacaine plasma levels following caudal anaesthesia. Anaesthesist. 1998; 47: 290-4.

  • 12. Eyres RL Bishop W Oppenheim RC Brown TC. Plasma bupivacaine concentrations in children during caudal epidural analgesia. Anaesth Intensive Care. 1983; 11: 20-2.

  • 13. Merkel SI Voepel-Lewis T Shayevitz JR Malviya S. A behavioral scale for scoring postoperative pain in young children. Pediatr Nurse. 1997; 23:293-7.

  • 14. Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995; 7: 89-91.

  • 15. Hong JY Han SW Kim WO Cho JS Kil HK. A comparison of high volume/low concentration and low volume/high concentration ropivacaine in caudal analgesia for pediatric orchiopexy. Anesth Analg. 2009; 109: 1073-8.

  • 16. Takasaki M Dohi S Kawabata Y Takahashi T. Dosage of lidocaine for caudal anesthesia in infants and children. Anesthesiology. 1977; 47: 527-9.

  • 17. Schrock CR Jones MB. The dose of caudal epidural analgesia and duration of postoperative analgesia. Paediatr Anaesth. 2003; 13: 403 -8.

  • 18. Gunter JB Dunn CM Bennie JB Pentecost DL Bower RJ Ternberg JL. Optimum concentration of bupivacaine for combined caudal-general anesthesia in children. Anesthesiology. 1991; 75: 57 -61.

  • 19. Larousse E Asehnoune K Dartayet B Albaladejo P Dubousset AM Gauthier F et al. The hemodynamic effects of paediatric caudal anesthesia assessed by esophageal doppler. Anesth Analg. 2002; 94: 1165-8.

  • 20. Dalens B Hasnaoui A. Caudal anesthesia in pediatric surgery: success rate and adverse effects in 750 consecutive patients. Anesth Analg. 1989; 68: 83-9.

Search
Journal information
Impact Factor
IMPACT FACTOR 2018: 0.2
5-year IMPACT FACTOR: 0.293

CiteScore 2018: 0.30

SCImago Journal Rank (SJR) 2018: 0.172
Source Normalized Impact per Paper (SNIP) 2018: 0.237

Cited By
Metrics
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 158 69 5
PDF Downloads 105 52 2