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The effect of perioperative and postoperative caudal block on pain control in children
1Department of Anesthesia, Shriners Hospitals for Crippled Children, Tampa, Florida, USA.
Insights
This study found no significant difference in postoperative pain management for pediatric clubfoot surgery when comparing pre-incision versus post-incision caudal bupivacaine. Both methods provided similar analgesic needs within 48 hours.
Area of Science:
- Pediatric Anesthesiology
- Orthopedic Surgery
- Pain Management
Background:
- Clubfoot deformities are common in pediatric patients.
- Posterior medio-lateral release is a surgical procedure for clubfoot.
- Effective postoperative pain control is crucial for pediatric surgical recovery.
Purpose of the Study:
- To compare the efficacy of pre-incision versus post-incision caudal bupivacaine for postoperative pain relief in pediatric clubfoot surgery.
- To evaluate the impact of timing of caudal bupivacaine administration on analgesic requirements.
Main Methods:
- Double-blind, randomized study of ten pediatric patients undergoing bilateral clubfoot surgery.
- Two groups received caudal bupivacaine (0.25%) at different timings: pre-incision or 15 minutes post-incision.
- Postoperative pain assessed using a pediatric pain scale, with morphine as rescue analgesia.
Main Results:
- No significant difference in cumulative postoperative analgesic requirements within 48 hours between the two groups.
- No significant difference in the time to the first postoperative analgesic administration.
- Both pre-incision and post-incision caudal bupivacaine demonstrated comparable pain management outcomes.
Conclusions:
- The timing of caudal bupivacaine administration (pre-incision vs. post-incision) does not significantly affect postoperative pain control in pediatric clubfoot surgery.
- Current anesthetic and analgesic protocols appear adequate for managing pain in this patient population.
- Further research may explore alternative or adjunct pain management strategies.
Abstract:
Ten paediatric patients (ASA status 1) who had bilateral club foot deformities and underwent bilateral posterior medio-lateral release within a two week interval (one foot operated each time) were assigned to one of two groups in a double-blind manner. Group one received caudal bupivicaine (0.25%) 2 mg.kg-1 before the surgical incision, followed by caudal normal saline infused at the same volume after the surgical incision. Group two received caudal saline before surgical incision followed by caudal bupivicaine (0.25%) infused 15 min after the surgical incision. No additional analgesic was used before or during the operation. Patients were selected in a manner that allowed each patient to be assigned to either group one or two during the first or second surgical episodes. Anaesthesia was induced with halothane and maintained with nitrous oxide and isoflurane. The anaesthesiologist following the patient for postoperative pain control and analgesic requirement was blinded to the regional technique. Postoperative pain was rated on a paediatric pain scale. Children received a morphine suppository at the appropriate dose related to the body weight for postoperative pain control. There was no significant difference in the cumulative postoperative analgesic requirements within the first 48 h, nor in the time to the first postoperative analgesic administration between the two groups.