Postoperative analgesia and intraoperative inhalational anesthetic requirements during umbilical herniorrhaphy in children: postincisional local infiltration versus preincisional caudal epidural block

Abstract

Study objective: To determine the postoperative analgesic efficacy of, and the effects on, intraoperative inhalational anesthetic requirements of preincisional caudal epidural block versus postincisional infiltration of local anesthetic following umbilical herniorrhaphy in children.

Design: Randomized, double-blind, prospective study.

Setting: University medical center.

Patients: 16 ASA status I and II patients (11 males, 5 females), ages 11 to 20 months, weighing up to 17 kg.

Interventions: During standard anesthetic care, 16 children were randomized to receive either caudal block with 1.5 ml/kg of 0.2% bupivacaine (group I) or local infiltration of the surgical site with up to 1.2 ml/kg of 0.25% bupivacaine (Group 2).

Measurements and main results: Patients in Group I had significantly decreased pain scores and requirements for supplemental postoperative intravenous (IV) fentanyl. Five of eight patients in Group 1 did not require supplemental IV fentanyl during their in-hospital postoperative course, while all eight patients in Group 2 required supplemental IV fentanyl. The patients who received caudal epidural block also had decreased intraoperative requirements for isoflurane, shorter time to extubation (4.1 +/- 0.8 min vs. 8.4 +/- 1.5 min), and quicker discharge home (129 +/- 13 min vs. 163 +/- 22 min). Five of eight patients in Group 1 were ready for discharge at our usual time of 120 minutes, as opposed to one of eight patients in Group 2.

Conclusion: Preincisional caudal epidural block is more effective in controlling pain following umbilical herniorrhaphy than is postincisional local infiltration.