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Postoperative voiding interval and duration of analgesia following peripheral or caudal nerve blocks in children
Q A Fisher1, C M McComiskey, J L Hill
1Department of Anesthesiology, University of Maryland, Baltimore.
Insights
Postoperative pain management in children undergoing minor surgery is effective with regional anesthesia. Caudal blocks with or without epinephrine and ilioinguinaliliohypogastric nerve blocks provide similar pain relief and do not delay voiding.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pediatric Surgery
Background:
- Postoperative pain control is crucial for pediatric surgical recovery.
- Regional anesthesia techniques are increasingly used for pediatric pain management.
- Understanding the impact of different regional blocks on voiding and analgesia is important.
Purpose of the Study:
- To compare the time to postoperative micturition and duration of analgesia.
- To evaluate the effectiveness of caudal block with and without epinephrine versus ilioinguinaliliohypogastric nerve block.
- To assess pain scores and analgesic requirements in pediatric patients.
Main Methods:
- 82 children (6 mo-10 yr) undergoing herniorrhaphy or orchiopexy received general anesthesia.
- Randomized assignment to caudal block (0.75 mL/kg 0.25% bupivacaine), caudal block with epinephrine, or ilioinguinaliliohypogastric nerve block.
- Postoperative pain and voiding times were monitored by blinded observers.
Main Results:
- No significant difference in time to micturition among the three regional anesthesia groups.
- Similar rates of pain-free periods (>4 hours) and analgesic requirements within 24 hours across groups.
- Seven patients exceeding 8 hours for voiding required no intervention.
Conclusions:
- Regional anesthesia techniques, including caudal blocks and ilioinguinaliliohypogastric nerve blocks, are effective for pediatric postoperative analgesia.
- Caudal analgesia does not prolong the time to postoperative voiding in children.
- Bupivacaine with or without epinephrine in caudal blocks and ilioinguinaliliohypogastric nerve blocks offer comparable outcomes.
Abstract:
We studied the time to postoperative micturition and the duration of analgesia in 82 children aged 6 mo to 10 yr undergoing herniorrhaphy or orchiopexy under general anesthesia with N2O and halothane. All received D5 lactate Ringer's solution equivalent to 6 h maintenance intraoperatively, and oral fluids postoperatively ad libitum. At the end of surgery, patients were randomly assigned to receive one of three regional anesthetic injections using 0.25% bupivacaine: caudal, 0.75 mL/kg (group I); caudal with 1:200,000 epinephrine, 0.75 mL/kg (group II); or ilioinguinaliliohypogastric nerve block with epinephrine through the wound by the surgeon (group III). Postoperatively, blinded observers scored pain at 30 min, hourly until discharge, and by telephone at 24-36 h. In the 74 patients with successful blocks (mean age 2.5 +/- 2.4 yr), the times to micturition (group I, 202 +/- 130 min; group II, 262 +/- 164 min; group III, 196 +/- 101 min) did not differ significantly among groups. Seven patients who took more than 8 h to void required no intervention. There was no difference in the numbers without pain for > or = 4 h (74%, 64%, and 69% of groups I, II, and III), or those requiring analgesics by 24 h (66% overall). The time to postoperative voiding in children is variable and not prolonged by caudal analgesia; caudal bupivacaine with or without epinephrine and ilioinguinaliliohypogastric nerve block are equally effective for postoperative analgesia.