Safety and Analgesic Efficacy of Spinal Versus Caudal Block in Pediatric Infra-Umbilical Surgery

Abstract
Background: Neuraxial analgesia may improve post-operative outcomes for high-risk children who are susceptible to respiratory complications (e.g. post-operative apnea). The use of spinal anesthesia in infants and children requiring surgeries of sub-umbilical region is gaining considerable popularity worldwide. Caudal analgesia along with general anesthesia is a very popular regional technique for prolonged post-operative analgesia in different pediatric surgical proce-dures where the surgical site is sub-umbilical. Bupivacaine has been thoroughly studied, and a large global experience exists.
Aim of Study: Was to investigate the safety and analgesic efficacy of spinal versus caudal bupivacaine combined with sevoflurane anesthesia in children undergoing infra-umbilical surgeries.
Material and Methods: One hundred thirty patients of either sex aged between 2-7 years, (ASA I or II) were randomly assigned into two groups of 65 subjects each; Group A (caudal bupivaciane group) and Group B (spinal bupivaciane group). Group A received caudal isobaric bupivacaine, Group B received spinal hyper baric bupivacaine. Both after anesthesia induction and before surgery. Assessment parameters included; time to 1st oral rescue analgesics, post-operative (FLACC scale), post-operative agitation, post-operative motor block component, haemodynamics, perioperative adverse effect.
Results: There were no significant differences between the two studied groups in the mean post-operative FLACC scores at any time except in the second post-operative hour in the spinal group (0.84±0.07 Vs. 1.13±0.08, p<0.01). The time to first request for rescue analgesia was significantly lower in the spinal group (6.60±1.82 Vs. 9.23±2.47, p<0.00), compared with the caudal group. There were no differences between the two studied groups in the total IV paracetamol consumption in the 1st 24h post-operatively (p=0.0674). There were no significant differences in the mean post-operative modified bromage scale scores between the two studied groups at any time. The block was associated with few complications in both groups.
Conclusion: This study demonstrated that the spinal analgesia is fairly comparable to caudal analgesia in pediatric patients undergoing sub-umbilical surgeries. And we recom-mend the addition of an adjuvant to the intrathecal bupivacaine to prolong its analgesic effect making spinal analgesia a suitable alternative to caudal analgesia.