MJMR, Vol. 31, No. 3, 2020, pages (236-239). Ibrahim et al.

Research Article

Is Caudal Block Has an Effect on postoperative

Pediatric Hemodynamics?

Ibrahim T. Ibrahim, Shadwa R. Hassanein and Arwa Essam Anwar

Department of Anesthesia and Intensive Care, El-Minia Faculty of Medicine

Abstract
Background: Caudal block is the most commonly used technique of regional anesthesia performed
on children that is suitable for use during various types of surgical interventions located below the
level of the navel .This technique provides a safe approach to the epidural space in children. Patients
and Methods: A total of 40 pediatric patients of both sex, ASA I and II, aged between 2 to 6 years,
scheduled for lower abdominal surgery, under general anesthesia were included in the study. Patients
were randomly allocated into 2 equal groups each containing 20 patient. Group (CB) received
ultrasound guided Caudal Block in a dose 2.5mg/kg of bupivacaine (0.25%) and group (C) didn’t
receive any block. Results: There was a significant increase in HR, Systolic and Diastolic blood
pressure in the Control group than (CB) group that had more hemodynamic stability Conclusion: we
concluded that caudal block is an easy and safe technique and causes more hemodynamic stability.
Keywords: caudal block, regional anesthesia, pediatrics.

Introduction
Caudal epidural block is a popular and reliable usually performed after general anesthetic
technique in lower abdominal surgeries induction or sedation. Regional techniques
especially in children as it provides hemo- combined with general anesthetics in the
dynamic stability and analgesia during both pediatric population reduce the consumption of
intra and postoperative period(1). intraoperative analgesics and volatile anesth-
etics, decrease the stress response to surgery
Some guidelines must be followed when and promote rapid and painless recovery from
analgesia is administered to children; a pain- operation. The site and type of surgical
related treatment program should provide procedure are important when choosing a
medication preference, appropriate dosage method(3).
intervals, prompt half-life drug usage, or ideally
oral medication administration. Different Ultrasound allows the anatomical structures to
medications should be selected depending on be visualized in real time, directs the blocking
the procedure conducted by the age and pain process itself, and displays the distribution of
level of the patient (2). the injected local anesthetic solution. For
pediatrics, where most blocks are in
The following interventions are prescribed anesthetized patients, a faster onset of block
according to pain level as pediatric post- using less local anesthetic solution is
operative pain management strategies; mild particularly appealing. Ultrasound guidance
pain: non-steroidal analgesics (NSAID); mode- may also be useful in infants and children for
rate pain: NSAID, NSAID and opioid combi- caudal and epidural blocks, as the sacrum and
nation, IV opioids (continuous injection, PCA, the vertebrae are not fully ossified. Ultrasound-
continuous opoid administration) and regional guided techniques for infraclavicular brachial
anesthetics; extreme pain: IV opioids and plexus blocking and the lumbar plexus block in
regional anesthetics (3). pediatrics have been identified (4).

The children can use all regional block Aim of the work
strategies used in adults. Regional procedures Evaluation of the hemodynamic effect of caudal
for postoperative pain control in children are block in the post-operative period.

236 Is Caudal Block Has an Effect on postoperative

Pediatric Hemodynamics?
MJMR, Vol. 31, No. 3, 2020, pages (236-239). Ibrahim et al.,

Patients and methods • Infection at site of injection.

After approval of university ethical committee
and written informed consent from parent of the Patients'groups
children, this prospective randomized double Patients were randomly allocated into 2 equal
blind controlled study was conducted in Minia groups each containing 20 patients. Group (CB)
University hospital during the period from received ultrasound guided Caudal Block in a
February 2019 to January 2020. A total of 40 dose 2.5mg/kg of bupivacaine (0.25%) and
pediatric patients of both sex, ASA I and II, group (C) didn’t receive any block. Anesthetic
aged between 2 to 6 years, scheduled for lower technique was standardized in both groups.
abdominal surgery, under general anesthesia Systolic and Diastolic Arterial Blood Pressure,
were included in the study. O2 saturation were assessed.
Exclusion criteria: Results
• History of allergy to the studied drug. The two studied groups were comparable as
• Spinal and Meningeal Anomalies. regards the age, sex distribution, with no
• History of developmental delay. significance as shown in table (1).
• Blood Disease.
Table (1): Demographic data in the studied groups (data presented as mean ± SD or number
and percentage)

Group Controls
Variable P value
CB C
Age
2-6 2-6
Range 0.772
3.57±1.38 3.89±1.60
Mean ±SD
Sex
Male 9(45%) 10(50%) 0.693
Female 11(55%) 10(50%)

There was a significant increase in HR in (C) group in studied interval when compared with basal
value while in (CB) group there was more stability in HR as shown in table (2).

Table (2): Postoperative changes in the heart rate (beat/min) (data presented as mean ± SD)

Group Control
HR P value
CB C
At PACU
83-120 87-130
Range 0.000**
98.40±10.13 107.52±12.25
Mean±SD
At 2 hour #
82-117
Range 83-139 0.000**
96.51±8.47
Mean ±SD 112.01±14.64
At 4 hour #
74-129
Range 102-132 0.000**
96.19±13.25
Mean ±SD 117.32±7.20
At 6 h #
Range 79-119 93-122 0.000**
Mean ±SD 103.59±10.59 109.06±6.78
At 12 h #
99-124
Range 94-119 0.008**
110.71±6..57
Mean ±SD 106.64±7.25

237 Is Caudal Block Has an Effect on postoperative

Pediatric Hemodynamics?
MJMR, Vol. 31, No. 3, 2020, pages (236-239). Ibrahim et al.,

There was a significant increase in the systolic and diastolic blood pressure in (C) group than in (CB)
group in the postoperative period as shown in tables (3) and (4).

Table (3): Post-operative changes in the Systolic blood pressure (mmHg)

(data presented as mean ± SD).

Group Control
SBP P value
CB C
At PACU
80-100 90-100
Range 0.000**
88.24±5.45 95.49±2.24
Mean±SD
At 2 hour # #
Range 80-90 90-100 0.000**
Mean ±SD 86.75±5.45 97.24±4.14
At 4 hour # #
Range 80-100 95-100 0.000**
Mean ±SD 86.00±5.76 99.25±3.73
At 6 h # #
Range 80-100 90-105 0.000**
Mean ±SD 93.75±5.35 97.25±3.43
At 12 h #
95-105
Range 80-100 0.005**
96.40±2.35
Mean ±SD 94.75±4.72

Table (4): Changes in the Diastolic blood pressure (mmHg) (data presented as mean ± SD).

Group Control
DBP P value
CB C
At PACU
50-60 50-70
Range 0.005**
52.74±3.5 54.5±5.31
Mean±SD
At 2 hour
50-60 50-75
Range 0.000**
52.25±3.43 55.51±5.84
Mean ±SD
#
At 4 hour #
Range 50-55 0.000**
50-75
Mean ±SD 51.51±2.36
55.51±6.1
At 6 h
Range 50-60 55-70 0.000**
Mean ±SD 52.75±3.44 55.75±5.90
At 12 h
50-60 50-70
Range 0.008**
53.25±3.35 55.75±5.91
Mean ±SD

There was no significant difference between the two studied groups as regarding the arterial oxygen
saturation in the postoperative period as shown in (Table 5)

238 Is Caudal Block Has an Effect on postoperative

Pediatric Hemodynamics?
MJMR, Vol. 31, No. 3, 2020, pages (236-239). Ibrahim et al.,

Table (5): Changes in the arterial oxygen saturation (SaO2) in percentage

(data presented as mean ± SD).

Group Controls
SaO2 P value
CB C
At PACU
98-99 97-99
Range 0.374
98.95± 0.22 98.75± 0.76
Mean ±SD
At 2 hour
Range 98-100 98-99 0.726
Mean ±SD 98.95±0.39 98.80±0.22
At 4 hour
Range 98-100 99-100 0.486
Mean ±SD 99.05±0.22 98.85±0.39
At 6 h
Range 99-100 98-99 0.232
Mean ±SD 99.05±0.39 98.90±0.22

Discussion venous analgesia versus general anesthesia

Caudal block is the most common technique of with caudal analgesia in pediatric patients
regional anesthesia used to relieve pain in undergoing open-heart surgery. Annals of
children following lumbosacral to midthoracic Cardiac Anaesthesia. 2019 Jan; 22(1):35
dermatomal surgery. Caudal block is associated 2. Kulshrestha A, Bajwa SJS. Management
with limited analgesic length using single shot of acute postoperative pain in pediatric
technique (5). patients. Anaesth Pain & Intensive Care
2014;18(1):101-107.
We found more hemodynamic stability in group 3. Fein JA, Zempsky WT, Cravero JP,
(CB) than Controlled group. Our results were in Committee on Pediatric Emergency
agreement with Acharya et al., 2013 compared Medicine. Relief of pain and anxiety in
2edifferent doses of fentanyl as an adjuvant for pediatric patients in emergency medical
caudal block in patients agede2-7eyears systems. Pediatrics. 2012 Nov 1; 130(5):
undergoing infraumblical surgery to assess e1391-405.
hemodynamics. They divided patients into three 4. Brasher C, Gafsous B, Dugue S, Thiollier
groups, group I received caudal block A, Kinderf J, Nivoche Y, Grace R,
withebupivacainee0.25% with normal saline, Dahmani S. Postoperative pain manage-
group II received caudal block with bupivacaine ment in children and infants: an update.
0.25%ewith fentanyle0.5mcg/kg and group III Pediatric Drugs. 2014 Apr 1; 16(2):129-40.
received caudal block with bupivacainee0.25% 5. Daftary AR and Karnik AS. Perspectives
with fentanyl 1mcg/kg, they reported no in ultrasound-guided musculoskeletal
statistical significance in hemodynamics pre- interventions. The Indian journal of
operative, intraoperative and postoperative radiology & imaging. 2015; 25:246.
between the three groups(6). 6. Acharya R, Jena SK, Samal S, Mishra
SN. Postoperative analgesia in pedia-
References trics patients through caudal block
1. Samantaray DJ, Trehan M, Chowdhry V, with bupivacaine and two different
Reedy S. Comparison of hemodynamic doses of fentanyl-A comparative
response and postoperative pain score study. J Evol Med Dent Sci. 2013;2
between general anaesthesia with intra- (2):7568-4.

239 Is Caudal Block Has an Effect on postoperative

Pediatric Hemodynamics?