Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Timing of caudal block placement in relation to surgery does not affect duration of postoperative analgesia in paediatric ambulatory patients

Abstract

The purpose of this study was to determine if the timing of caudal block placement in relation to surgery affected either the duration of postoperative pain relief or the discharge time in children undergoing brief ambulatory surgical procedures. Forty ASA physical status I or II children ages 18 mo to 11 yr were randomly assigned to one of two groups. Group I patients received a caudal block with 0.5 ml · kg−1 of bupivacaine 0.25 per cent following the induction of anaesthesia but before the onset of surgery. Group 2 patients received a similar block at the completion of surgery but before emergence from general anaesthesia. An experienced observer, who was not aware of the timing of block placement, observed all patients from arrival to the post-anaesthetic recovery room until discharge from the ambulatory surgery unit. Pain was assessed at five-minute intervals using an Objective Pain Scale. No statistically significant differences were noted between Group I and Group 2 patients with regard to their postoperative pain/discomfort scores, the need for postoperative narcotic analgesia, or the time required for either group to meet standard discharge criteria. It is concluded that the duration of postoperative analgesia is not impaired by placing the caudal block prior to the start of a brief surgical procedure.

Résumé

Faire un bloc caudal avantplutôt qu’aprèsune courte intervention chirurgicale en externe importe t’il sur la durée de l’analgésic et le moment du congé? Nous avons randomisés 40 enfants de 18 mois à 11 ans et de classe ASA I on II en deux groupes. Sous anesthésie générate, nous faisions un bloc caudal avec 0,5 ml · kg−1 de bupivacaïne à 0,25 pour cent juste avant le debut de la chirurgie dans le groupe I et juste apres la fin celle-ci dans le groupe II. De leur arrivée en salle de réveil jusqu’ à leur départ pour la maison, un observateur indépendant notait au cinq minutes l’intensite de la douleur des enfants sur une échelle objective. Nous n’avons observé aucune différence statistique entre les groupes quant l’intensité des douleurs, à la quantité de morphinique necessaire pour les soulager non plus qu’au temps requis pour rencontrer les critères habituels de congé. Il semble done que la durée de l’analgésie post-opératoire soit adéquate même si on fail le bloc caudal avant plutôt qu après une brève intervention chirurgicale.

References

  1. 1

    Shandling B, Steward DJ. Regional analgesia for postoperative pain in pediatric outpatient surgery. J Pediatr Surg 1980; 15: 477–80.

  2. 2

    Anderson R, Krogh K. Pain as a major cause of postoperative nausea. Can Anaesth Soc J 1976; 23: 366.

  3. 3

    Hannallah RS, Broadman LM, Belman AB, Abramowitz MD, Epstein BS. Comparison of caudal and ilioinguinal/iliohypogastric nerve blocks for control of post-orchiopexy pain in pediatric ambulatory surgery. Anesthesiology 1987; 66: 832–4.

  4. 4

    Wolf A, Valley RD, Fear DW, Roy WL, Lerman J. Bupivacaine for caudal analgesia in infants and children; the optimal effective concentration. Anesthesiology 1988; 69: 102–6.

  5. 5

    Broadman LM. Regional anesthesia for the pediatric outpatient. Anesth Clin North Am 1987; 5: 53–72.

  6. 6

    Aldrete JA, Krouli KD. A postanesthetic recovery score. Anesth Analg 1970; 49: 924–34.

  7. 7

    Broadman LM, Hannallah RS, Belman AB et al. Post-circumcision analgesia — a prospective evaluation of subcutaneous ring block of the penis. Anesthesiology 1987; 67: 399–402.

Download references

Author information

Correspondence to Linda Jo Rice.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Rice, L.J., Pudimat, M.A. & Hannallah, R.S. Timing of caudal block placement in relation to surgery does not affect duration of postoperative analgesia in paediatric ambulatory patients. Can J Anaesth 37, 429 (1990). https://doi.org/10.1007/BF03005620

Download citation

Key words

  • anaesthesia: paediatric
  • anaesthetic techniques: caudal
  • pain: postoperative
  • surgery: ambulatory