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Bupivacaine caudal epidural anesthesia: assessing the effect of general anesthetic technique on block onset

P M Ingelmo1, E J Bendall, G Frawley

  • 1Department of Anaesthesia and Intensive Care, A.O. San Gerardo, Monza, Italy.

Paediatric Anaesthesia
|February 1, 2007
PubMed

Insights

Sevoflurane anesthesia offers faster surgical anesthesia onset compared to propofol in children undergoing regional anesthesia. However, sevoflurane may increase recovery distress and residual motor blockade in younger children.

Area of Science:

  • Anesthesiology
  • Pediatric Anesthesia
  • Regional Anesthesia

Background:

  • Prospective, randomized trial comparing propofol and sevoflurane for regional anesthesia effectiveness.
  • Secondary objective: evaluate age influence on neuraxial block profile.

Purpose of the Study:

  • Compare propofol vs. sevoflurane effects on regional anesthesia.
  • Assess age-related differences in anesthetic effects.

Main Methods:

  • 113 healthy children (<10 years) received propofol or sevoflurane.
  • Caudal or lumbar epidural block administered.
  • Evaluated anesthesia onset, intraoperative analgesia, motor blockade, pain, and adverse effects.
  • Children categorized into 0-24, 25-60, and >60 months age groups.

Main Results:

  • Sevoflurane group showed significantly shorter anesthesia onset time (3.1 vs. 4.7 min).
  • Increased distress on arousal observed in the sevoflurane group (P=0.03).
  • Higher incidence of residual motor blockade at 3 hours in infants (0-24 months) receiving sevoflurane (P=0.01).

Conclusions:

  • Sevoflurane anesthesia accelerates surgical anesthesia onset compared to propofol, especially before caudal epidural blockade.
  • Potential mechanism involves differential receptor binding in the spinal cord.
  • Age influences residual motor blockade incidence, with younger infants more affected by sevoflurane.
Abstract

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