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Effect of caudal block on stress responses in children
Sema Tuncer1, Alper Yosunkaya, Ruhiye Reisli
1Department of Anesthesiology, Meram Medical Faculty, Selcuk University, Konya, Turkey. tuncersema@hotmail.com
Insights
Caudal anesthesia effectively reduces stress responses in children undergoing lower abdominal surgery. This technique lowers plasma cortisol, prolactin, and glucose levels, indicating a suppressed endocrine and metabolic reaction to surgical stress.
Area of Science:
- Pediatric Anesthesiology
- Surgical Stress Response
- Endocrinology
Background:
- Lower abdominal and genitourinary surgeries pose significant stress to pediatric patients.
- Understanding the endocrine and metabolic responses to surgical stress is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the impact of caudal block anesthesia on key hormonal and metabolic markers during and after pediatric lower abdominal surgery.
- To assess the suppression of stress responses, including cortisol, prolactin, insulin, and glucose levels, through caudal anesthesia.
Main Methods:
- A randomized study involving 30 male children (3-10 years) undergoing elective surgery.
- Children were divided into a control group and a caudal block group receiving 0.25% bupivacaine.
- Blood samples were collected at baseline, during surgery (T1), and post-surgery (T2) to measure hormone and glucose concentrations.
Main Results:
- Caudal anesthesia led to significantly lower plasma prolactin and cortisol levels at T1 and T2 compared to the control group.
- Glucose concentrations were lower in the caudal group at T1, despite an overall increase in both groups during surgery.
- Insulin levels were also reduced in the caudal group at T2.
Conclusions:
- Caudal anesthesia demonstrates a significant ability to suppress the metabolic and endocrine stress responses in children undergoing lower abdominal and genitourinary procedures.
- This suggests caudal block is an effective anesthetic technique for mitigating surgical stress in pediatric patients.
Background:
The present study was performed during lower abdominal and genitourinary surgery, to assess the effects of caudal block on plasma cortisol, prolactin, insulin and glucose concentrations during and after surgery.
Methods:
Thirty male children aged 3-10 years who were scheduled for elective surgery, were selected for the study. The children were premedicated with oral midazolam 0.5 mg/kg. All children received induction with nitrous oxide in oxygen and sevoflurane. The children were randomly allocated into two groups: Group I, control group (n = 15) and group II, caudal group (n = 15). Anesthesia was maintained by face mask with the same agent in both groups. Caudal block was performed with 0.25% bupivacaine 2 mg/kg after induction of anesthesia in the caudal group. Blood samples were obtained after induction of anesthesia (T(0)) in order to measure baseline concentrations of cortisol, prolactin, glucose and insulin. Additional samples were obtained 30 min after the start of surgery (T(1)), and 60 min after the end of surgery (T(2)).
Results:
All of the basal values (T(0)) were within the normal ranges accepted by Meram Medical Faculty of Selcuk University for children of this age group and there were no differences between the groups (P > 0.05). In both groups, glucose concentration increased at T(1), compared with T(0) and T(2) values (P < 0.05). However glucose concentration was lower in the caudal group than in the control group at T(1) (P < 0.05). In both groups, prolactin concentration increased at T(1), compared with T(0) (P < 0.05). The mean plasma prolactin and cortisol concentration were lower in the caudal group than the control group at T(1) and T(2) (P < 0.05). The mean insulin concentration was lower in the caudal group than the control group at T(2) (P < 0.05).
Conclusion:
These results indicate that caudal anesthesia suppresses the metabolic and endocrine responses to stress associated with lower abdominal and genitourinary surgery in children.
