A Comparison of Three Different Volumes of Levobupivacaine for Caudal Block in Children Undergoing Orchidopexy and Inguinal Hernia Repair

Abstract

Objective: The aim of this study was to compare the efficacy of 3 different volumes of 0.25% levobupivacaine caudally administered on the effect of intra- and postoperative analgesia in children undergoing orchidopexy and inguinal hernia repair. Subjects and Methods: Forty children, aged 1-7 years, American Society of Anesthesiologists (ASA) physical status I and II, were randomized into 3 different groups according to the applied volumes of 0.25% levobupivacaine: group 1 (n = 13): 0.6 mL∙kg^-1; group 2 (n = 10): 0.8 mL∙kg^-1; and group 3 (n = 17): 1.0 mL∙kg^-1. The age, weight, duration of anesthesia, onset time of intraoperative analgesic, dosage, and addition of intraoperative fentanyl were compared among the groups. The time to first use of the analgesic and the number of patients who required analgesic 24 h after surgery in the time intervals within 6 h, between 6 and 12 h, and between 12 and 24 h postoperatively were evaluated among the groups. Statistical analyses were performed with a Dunnett t test, ANOVA, or Kruskal-Wallis test and χ² test. Logistic regression analysis was used in order to examine predictive factors on duration of postoperative analgesia. Results: Age, weight, duration of anesthesia, onset time of intraoperative analgesic, dosage, and addition of intraoperative fentanyl were similar among the groups. The time to first analgesic use did not differ among the groups, and logistic regression modelling showed that using the 3 different volumes of levobupivacaine had no predictive influence on duration of postoperative analgesia. The numbers of patients who required analgesics within 6 h (3/2/3), between 6 and 12 h (3/1/3), and between 12 and 24 h (1/0/2) after surgery were similar among the groups. Conclusion: The 3 different volumes of 0.25% levobupivacaine provided the same quality of intra- and postoperative pain relief in pediatric patients undergoing orchidopexy and inguinal hernia repair.

4. Comparison of the Postoperative Analgesic Effects of Levobupivacaine Wound Instillation with a Placebo after Unilateral Inguinal Hernia Repair: a Randomized-controlled Trial

“…The expected adverse reactions were inadequate analgesia, local reaction to the anaesthetic, and delayed urine derivation in the post-operative period (albeit very rare in children). However, adverse reactions were not reported, which is in line with previous studies (7,9,20,21).…”

Regional anesthesia to ameliorate postoperative analgesia outcomes in pediatric surgical patients: an updated systematic review of randomized controlled trials

“…Two studies evaluated the efficacy of caudal epidural anesthesia on postoperative analgesia in children undergoing orchiopexy and inguinal hernia repair. 30 , 40 One study evaluated three different volumes of 0.25% levobupivacaine (low: 0.6 mL/kg; middle: 0.8 mL/kg; and high: 1.0 mL/ kg) and reported that the postoperative analgesic consumption at 6, 12, and 24 hours following surgery did not differ among groups. The postoperative pain was evaluated using the CHIPPS instrument which was not statistically different among groups at any time period.…”

Analgesic Effects of Regional Analgesic Techniques in Pediatric Inguinal Surgeries: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

“…Previous RCTs showed that caudal block of 1 mL kg –1 and <1 mL kg –1 had similar analgesic effects in inguinal hernia repair, orchiopexy, and circumcision. 101,102 This might be explained by the small correlation between the caudal block volume and the cranial spread of local anesthetic under ultrasound assessment. 103 Although caudal block with 1.5 mL kg –1 reaches T6 under fluoroscopy and increases analgesic effects compared with 1.0 mL kg –1 in children undergoing orchiopexy, 104 such a volume was reported to cause immediate and major reductions in cerebral blood flow and cerebral regional oxygenation in infants <3 months.…”