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A study of the effect of caudal epidural block on bispectral index targeted propofol requirement in children: A

Abhishek Banerjee¹, Bibhukalyani Das¹, Dipankar Mukherjee¹

¹Department of Anaesthesiology, NRS Medical College and Hospital, Kolkata, West Bengal, India.

Journal of Indian Association of Pediatric Surgeons

|April 2, 2015

Insights

Caudal epidural block significantly reduced intravenous propofol requirements in pediatric patients undergoing infra-umbilical surgery. This technique offers reliable analgesia and anesthetic sparing effects, improving patient outcomes.

Area of Science:

Anesthesiology
Pediatric Surgery
Pain Management

Background:

Neuraxial anesthesia, including caudal epidural block, can reduce general anesthesia requirements due to inherent sedative properties.
Total Intravenous Anesthesia (TIVA) with propofol is a standard anesthetic maintenance method for children.
Caudal analgesia may decrease the need for sedative hypnotics and volatile anesthetics in pediatric patients undergoing surgery.

Purpose of the Study:

To compare propofol dose requirements in pediatric patients undergoing infra-umbilical surgery with and without caudal epidural analgesia.
To evaluate the efficacy of propofol as a maintenance anesthetic agent.
To compare the hemodynamic stability between caudal epidural analgesia and IV analgesia groups.

Main Methods:

A randomized, prospective, double-blinded study involving 82 pediatric patients (3-6 years) undergoing infra-umbilical surgery.
Patients were allocated to two groups: Group A (general anesthesia with IV analgesia) and Group B (general anesthesia with caudal epidural block and IV analgesia).
Intra-operative propofol infusion was used for maintenance anesthesia, guided by Bispectral (BIS) monitoring (target 40-60), with propofol consumption calculated.

Main Results:

Propofol consumption at the end of surgery was significantly lower in the caudal epidural block group (7.83 ± 0.63 mg/kg/h) compared to the IV analgesia group (11.33 ± 0.17 mg/kg/h) (P < 0.05).
The time to administration of rescue analgesia was significantly longer in the caudal epidural block group (6.5 hours) versus the IV analgesia group (2.1 hours) (P < 0.05).
No statistically significant difference was observed in the incidence of adverse effects between the two groups.

Conclusions:

Caudal epidural blockade effectively reduces the requirement for intravenous propofol in BIS-monitored pediatric patients undergoing infra-umbilical surgery.
This technique provides significant anesthetic-sparing effects and prolonged analgesia, contributing to improved peri-operative care.
Caudal epidural analgesia is a valuable adjunct for maintaining anesthesia and managing pain in pediatric surgical patients.

Read full analysis

Abstract

Unlabelled:

Caudal epidural block is one of the most commonly performed neuraxial block techniques with reliable peri-operative and post-operative analgesia in pediatric patients. In our randomized, prospective, double-blinded, open level, parallel group study, we have established the effect of caudal epidural block on maintenance requirement of intravenous (IV) propofol in targeted bispectral (BIS) monitored patients.

Context:

Neuraxial anesthesia exhibits sedative properties that may reduce the requirement for general anesthesia. TIVA with propofol has been administered as an established method of maintaining general anesthesia in children. Caudal analgesia being a type of neuraxial block, also seems to reduce the requirement of sedative hypnotics in pediatric patients. Numerous studies show that for patients, administered with caudal epidural block, they require reduced intra-operative volatile inhalation anesthetics. In the present study, we have established the anesthetic sparing effect of Caudal Epidural Analgesia in children undergoing infra-umbilical surgical procedure and calculated the efficacy of propofol-infusion in maintaining adequate depth of anesthesia.

Aims:

(1) To study and compare the dose requirements of propofol using caudal epidural analgesia. (2) To calculate the efficacy of propofol as maintenance anesthetic agent in both groups and to compare hemodynamic stability of patients in both the techniques.

Settings And Design:

In our study, after administering general anesthesia to pediatric patients, we have administered caudal analgesia and IV analgesia to monitor the requirement of intra-operative propofol infusion using BIS monitor with a target value of 40-60 in both groups.

Materials And Methods:

82 patients (aged between 3 and 6 years) have been selected undergoing infra-umbilical surgery and randomly allocated into two groups containing 41 patients in each group. Both the groups group B and group A then intubated with glycopyrrolate, 2 mg/kg injection fentanyl, propofol till loss of verbal contact and atracurium at the rate of 0.5 mg/kg and group B has been administered caudal epidural blockade with 1 ml/kg 0.2% ropivacaine. Propofol infusion at the rate of 10 mg/kg/h is given as maintenance. BIS value has been recorded throughout and propofol requirement at the end of surgery has been calculated.

Statistical Analysis Used:

Numerical variables between groups have been analyzed using the Student's t-test and the Mann-Whitney U-test as applicable. Categorical variables have been analyzed using the Pearson's Chi-square test. P < 0.05 is considered statistically significant.

Results:

Consumption of propofol at the start of operation in the group A is 2.9 ± 0.17 and group B is 2.91 ± 0.17, which is not statistically significant (P > 0.05), whereas at the end of the operation in the group A is 11.33 ± 0.17 and group B is 7.83 ± 0.63, which is statistically significant (P < 0.05). Incidence of adverse effects is statistically insignificant between the two groups. The time for administration of rescue analgesic is 2.1 ± 0.88 in group A and 6.5 ± 0.17 in group B, which is statistically significant due to caudal analgesia.

Conclusions:

We conclude that in BIS-monitored patients (3-6 years) with infra-umbilical surgeries have shown a reduction in consumption of IV propofol due to caudal epidural blockade.

Keywords:

Anesthesia bispectral index monitor caudal propofol

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