Effect of caudal block on the plasma adrenaline and noradrenaline concentrations in paediatric patients undergoing ilioinguinal herniorrhaphy

Abstract

This study compared the effect of two anaesthetic techniques on the catecholamine levels in children undergoing ilioinguinal herniorrhaphy. Forty male paediatric patients ASA class I were allocated randomly to one of two groups: the control group (n = 20) received general anaesthesia including intravenous fentanyl; and the caudal group (n = 20) received caudal anaesthesia with bupivacaine 0.25% 1 mL kg-1 combined with general anaesthesia but without opioids. Plasma adrenaline and noradrenaline concentrations were measured at induction, at the end of surgery and in the post-anaesthesia care unit (PACU). In the caudal group, there were significant decreases in the adrenaline and noradrenaline concentrations at the end of surgery and in the PACU compared with baseline concentrations. In the control group, there was a significant increase in PACU concentrations of adrenaline and noradrenaline compared with baseline concentrations. These findings suggest that the addition of a caudal block to general anaesthesia in children undergoing ilioinguinal herniorrhaphy decreases significantly the neurohormonal responses to surgery.

Benefits of regional anesthesia in children

“…There is some evidence to suggest that severe stress may be pathological and contributes to postoperative morbidity and mortality; extreme catecholamine responses are associated with the worst outcome (88,89). Numerous publications attest to the efficacy of epidural, spinal, and peripheral nerve blocks in obtunding the neuroendocrine stress response (6,84,87,(90)(91)(92). The lack of definable endpoints, however, makes it difficult to assess whether one anesthetic technique is superior.…”

Anaesthetic management of a patient with microvillus inclusion disease for intestinal transplantation

“…Epidural analgesia confers excellent pain control without the drawbacks of narcotics on intestinal function. The demonstration that small doses of epidural bupivacaine are effective in decreasing the endocrine stress response to surgery has clinical relevance which should be emphasized in high‐risk children with a deficient nutritional condition (16,17). We believed that our patient would benefit from early extubation while maintaining satisfactory epidural analgesia with bupivacaine and low dose fentanyl avoiding interference with small bowel recovery.…”

Does adding intravenous fentanyl to caudal block in children enhance the efficacy of multimodal analgesia as reflected in the plasma level of catecholamines?

“…The unpaired t-test was used when each period was compared between the two groups. A power calculation was not performed; however, in two studies that we carried out previously with cohorts of 40 and 50 patients, respectively [8,9], a value greater than 80% was computed based on the significant differences yielded by the comparisons of epinephrine and norepinephrine plasma levels in two groups at all study times (T 0 , T 1 and T 2 ).…”

“…opioids with less side-effects, decreases the necessity for postoperative opioids requirement and enables a more rapid awakening [7]. Caudal epidural block has been demonstrated to modulate the surgical stress response in the paediatric population [8,9].…”