Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.02.007
Brazilian Journal of Anesthesiology
Scientific Article

Effects of caudal block in pediatric surgical patients: a randomized clinical trial

Efeitos do bloqueio peridural caudal em pacientes cirúrgicos pediátricos: estudo randomizado

Anna Uram Benka, Marina Pandurov, Izabella Fabri Galambos, Goran Rakić, Vladimir Vrsajkov, Biljana Drašković

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Abstract

Background
Surgery generates a neuroendocrine stress response, resulting in undesirable hemodynamic instability, alterations in metabolic response and malfunctioning of the immune system.

Objectives
The aim of this research was to determine the effectiveness of caudal blocks in intra- and postoperative pain management and in reducing the stress response in children during the same periods.

Methods
This prospective, randomized clinical trial included 60 patients scheduled for elective herniorrhaphy. One group (n = 30) received general anesthesia and the other (n = 30) received general anesthesia with a caudal block. Hemodynamic parameters, drug consumption and pain intensity were measured. Blood samples for serum glucose and cortisol level were taken before anesthesia induction and after awakening the patient.

Results
Children who received a caudal block had significantly lower serum glucose (p <  0.01), cortisol concentrations (p <  0.01) and pain scores 3 h (p =  0.002) and 6 h (p =  0.003) after the operation, greater hemodynamic stability and lower drug consumption. Also, there were no side effects or complications identified in that group.

Conclusions
The combination of caudal block with general anesthesia is a safe method that leads to less stress, greater hemodynamic stability, lower pain scores and lower consumption of medication.

Keywords

Caudal block, Stress response, General anesthesia, Children

Resumo

Justificativa
O estresse cirúrgico causa resposta neuroendócrina, resultando em instabilidade hemodinâmica indesejável, modificações na resposta metabólica e disfunção no sistema imune.

Objetivos
O objetivo deste estudo foi avaliar em pacientes pediátricos a eficácia do bloqueio peridural caudal no controle da dor intra e pós-operatória e na redução da resposta ao estresse nesses períodos.

Métodos
Estudo clínico prospectivo randomizado que incluiu 60 pacientes submetidos à herniorrafia eletiva. Um grupo (n = 30) recebeu anestesia geral, e o outro (n = 30) anestesia geral combinada a bloqueio caudal. Foram medidos os parâmetros hemodinâmicos, o consumo de drogas e a intensidade da dor. Amostras de sangue para medir glicemia e cortisol plasmático foram obtidas antes da indução e após o despertar dos pacientes.

Resultados
As crianças que receberam bloqueio peridural caudal apresentaram valores significantemente mais baixos para glicemia (p <  0,01), concentração de cortisol (p <  0,01) e escores de dor de 3 horas (p =  0,002 e 6 horas p =  0,003 após a cirurgia, maior estabilidade hemodinâmica e menor consumo de drogas. Além disso, não foram observados efeitos colaterais ou complicações neste grupo.

Conclusões
O bloqueio peridural caudal combinado à anestesia geral é uma técnica segura e que se associa o menor estresse, maior estabilidade hemodinâmica, redução nos escores de dor e baixo consumo de drogas.

Palavras-chave

Bloqueio caudal, Reposta ao estresse, Anestesia geral, Crianças

References


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