A study of the effect of caudal epidural block on bispectral index targeted propofol requirement in children: A comparative study

Abstract

Caudal epidural block is one of the most commonly performed neuraxial block techniques with reliable peri-operative and post-operative analgesia in pediatric patients. In our randomized, prospective, double-blinded, open level, parallel group study, we have established the effect of caudal epidural block on maintenance requirement of intravenous (IV) propofol in targeted bispectral (BIS) monitored patients.Context:Neuraxial anesthesia exhibits sedative properties that may reduce the requirement for general anesthesia. TIVA with propofol has been administered as an established method of maintaining general anesthesia in children. Caudal analgesia being a type of neuraxial block, also seems to reduce the requirement of sedative hypnotics in pediatric patients. Numerous studies show that for patients, administered with caudal epidural block, they require reduced intra-operative volatile inhalation anesthetics. In the present study, we have established the anesthetic sparing effect of Caudal Epidural Analgesia in children undergoing infra-umbilical surgical procedure and calculated the efficacy of propofol-infusion in maintaining adequate depth of anesthesia.Aims:(1) To study and compare the dose requirements of propofol using caudal epidural analgesia. (2) To calculate the efficacy of propofol as maintenance anesthetic agent in both groups and to compare hemodynamic stability of patients in both the techniques.Settings and Design:In our study, after administering general anesthesia to pediatric patients, we have administered caudal analgesia and IV analgesia to monitor the requirement of intra-operative propofol infusion using BIS monitor with a target value of 40-60 in both groups.Materials and Methods:82 patients (aged between 3 and 6 years) have been selected undergoing infra-umbilical surgery and randomly allocated into two groups containing 41 patients in each group. Both the groups group B and group A then intubated with glycopyrrolate, 2 mg/kg injection fentanyl, propofol till loss of verbal contact and atracurium at the rate of 0.5 mg/kg and group B has been administered caudal epidural blockade with 1 ml/kg 0.2% ropivacaine. Propofol infusion at the rate of 10 mg/kg/h is given as maintenance. BIS value has been recorded throughout and propofol requirement at the end of surgery has been calculated.Statistical Analysis Used:Numerical variables between groups have been analyzed using the Student's t-test and the Mann-Whitney U-test as applicable. Categorical variables have been analyzed using the Pearson's Chi-square test. P < 0.05 is considered statistically significant.Results:Consumption of propofol at the start of operation in the group A is 2.9 ± 0.17 and group B is 2.91 ± 0.17, which is not statistically significant (P > 0.05), whereas at the end of the operation in the group A is 11.33 ± 0.17 and group B is 7.83 ± 0.63, which is statistically significant (P < 0.05). Incidence of adverse effects is statistically insignificant between the two groups. The time for administration of rescue analgesic is 2.1 ...

Comparison of dose requirement of propofol with and without bispectral monitoring in patients undergoing spinal epidural anaesthesia: An institutional based study

“…By analysing the results, the authors came up to conclusion that a decline in the consumption of IV propofol occurred in BIS-monitored paediatric subjects. 13 In the epidural space, mechanism of action of anaesthetic solution occurs by three prominent ways. First mechanism says that most crucial factor in the arousal from anaesthesia is played by pain factor.…”

“…15 Results from previous studies also established that fact that by performing caudal blockage, there occurs a decline in the requirement of intraoperative inhalation anesthetic like sevoflurane. [12][13][14][15][16]…”

Minimum alveolar concentration of desflurane for maintaining BIS below 50 in children and effect of caudal analgesia on it

“…in their studies on pediatric population concluded that caudal analgesia decreases the arousal as determined by the BIS index monitoring during general anesthesia. [ 17 18 ] Hodgson and Liu found 34% reduction in the end-tidal sevoflurane concentration required for maintaining BIS <50 in lidocaine epidural anesthesia compared with general anesthesia alone group in adult patients. [ 9 ] Authors concluded that epidural anesthesia markedly reduced the amount of volatile general anesthetic required for adequate depth of anesthesia.…”

The Effect of Caudal Anesthesia Block on Perioperative Pain Control and Reduction of the Anesthetic Agent in Pediatric Infraumbilical Surgery

“…Fentanyl administration along with a volatile anesthetic, namely, sevoflurane is a well-established method for maintaining intraoperative GA in children undergoing pediatric surgery. [ 4 5 ] Yet, CEB is performed using bupivacaine 0.5% with a concentration of 0.25% and a volume of 1 mL.kg −1 . This can lead to reduction of the sedative-hypnotic requirement of GA in addition to its analgesic properties and the significant postoperative pain relief.…”

“…This can lead to reduction of the sedative-hypnotic requirement of GA in addition to its analgesic properties and the significant postoperative pain relief. [ 5 6 7 ]…”