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Caudal bupivacaine for postoperative analgesia in pediatric lower limb surgery
K A Payne1, M R Hendrix, W J Wade
1Department of Anesthesiology, Lady Michaelis Orthopaedic Hospital, University of Stellenbosch Medical School, Plumstead, South Africa.
Insights
Caudal bupivacaine in pediatric orthopedic surgery improved pain relief for 5-6 hours but increased urinary incontinence in the recovery phase. This study evaluated its effectiveness and side effects in children.
Area of Science:
- Pediatric Anesthesiology
- Orthopedic Surgery
- Pain Management
Background:
- Pediatric orthopedic surgery requires effective pain management.
- Caudal anesthesia is a common technique for lower limb procedures in children.
- Assessing the benefits and drawbacks of caudal bupivacaine is crucial.
Purpose of the Study:
- To evaluate the efficacy of caudal bupivacaine for postoperative analgesia.
- To assess the incidence of urinary incontinence following caudal anesthesia.
- To compare recovery room pain scores between groups.
Main Methods:
- 100 children (1-15 years) undergoing lower limb orthopedic surgery were randomized into two groups.
- One group received caudal bupivacaine (0.25%, 0.7 mL/kg), while the control group did not.
- Standard anesthetic techniques and surgery duration (>1 hour) were consistent.
Main Results:
- Caudal bupivacaine provided effective analgesia for 5-6 hours (P < .01).
- Urinary incontinence increased significantly in the caudal group (34%) compared to controls (14%) (P < .05).
- No fecal incontinence was reported in either group.
Conclusions:
- Caudal bupivacaine offers superior postoperative pain relief in pediatric orthopedic surgery.
- Increased urinary incontinence is a notable side effect requiring consideration.
- The benefits of improved analgesia should be weighed against potential adverse effects.
Abstract:
One hundred children aged 1 to 15 years were randomly allocated to two equal groups. All underwent cold orthopedic surgery to the lower limb, of more than 1 hour's duration with a standard anesthetic technique. One group received caudal bupivacaine 0.25%, 0.7 mL/kg, and one group acted as controls. There were no cases of fecal incontinence in the theater complex but urinary incontinence in the immediate recovery phase increased from 14% in the control group to 34% in the caudal group (P < .05). The caudal block had a duration of effect lasting 5 to 6 hours, and provided better recovery room analgesia (P < .01). The advantages for the child are discussed.