الفهرس 
Acknowledgments
Pediatric Caudal epidural blockOnly 14 pages are availabe for public view
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Abstract
This work had been carried out in Anesthesiology and Intensive care unit department, Asyut University Hospital and aimed to included 60 pediatric patients of both sex (20 patients in each group), their age between 2-6 years, scheduled to undergo an elective inguinal hernia repair operations and fulfill the inclusion criteria. The patients included in the study received general anesthesia with caudal analgesia, they allocated randomly into three groups as follows:
• Control group: 20 patients received caudal anesthesia using bupivacaine 0.125% 1ml/kg plus 2 ml normal saline.
• Nalbuphine group: 20 patients received caudal anesthesia using bupivacaine 0.125% 1ml/kg plus Nalbuphine 0.2 mg/kg in 2 ml solution.
• Fentanyl group: 20 patients received caudal anesthesia using bupivacaine 0.125% 1ml/kg plus fentanyl 1μg/kg in 2 ml solution.
Premedication in the form of 0.5 mg/ kg oral midazolam was given to all patients orally half an hour before induction of anesthesia.
All children were adequately hydrated by using ringer solution according to rule of 4:2:1 and all operations were performed in the morning as the first case in the schedual.
The anesthetic management of all cases was the same in the three groups; we used the Volatile Induction and Maintenance of Anesthesia method (VIMA) using sevoflurane in oxygen.
Single-dose caudal block using a 22 G needle was given by the drugs mentioned above according to the group.
Anesthesia was maintained with sevoflurane, intraoperative standard monitoring (ECG, NIBP, Pluse oximeter, Temperature, End Tidal Co2) was denoted every 15 min to the end of surgery which was allowed to start 15 minutes after caudal injection.
Postoperatively, hemodynamics, pain score, sedation and agitation state were assessed.
Postoperative pain was assessed by an experienced nurse who is unaware of the patient’s allocation using Face, Legs, Activity, Cry & consolability (FLACC) pain scale FLACC score every 2 h for 24h was done.
Agitation state was assessed using RICHMOND AGITATION-SEDATION SCALE (RASS score).
Adverse effects from caudal anaesthesia such as pruritus, flushing, vomiting, respiratory depression, and urine retention, all were checked for and documented.
Results
FLACC pain score, there was significant difference between the studied groups where we found that FLACC score was highest in control group (defective analgesia) and lowest in nalbuphine group (efficient analgesia).
As regard analgesic profile in our study we found that; In nalbuphine group, there was effective analgesia (FLACC score <4), while in fentanyl group duration of analgesia lasted for about 9.1±7.87 hour with analgesic consumption of IV paracetamol 236.5±248.91 mg /24 hour. While in control group, duration of analgesia lasted for only 7.95±2.05 h from the caudal block itself with IV paracetamol consumption of about 628.5±289.39 mg/24 hour.
Most of patients in nalbuphine group showed higher sedation scores than the other two groups in our study especially at the first 10 hours postoperatively and started to decrease gradually till they started to exhibit minimal degree agitation toward the end of the first 24 hours postoperative. While in control group, most of patients showed varying degrees of agitation all over the first 24 hours in the postoperative period especially at the first few hours postoperatively. Wherase, most of patients in fentanyl group showed minimal sedation scores only in the first six hours in the postoperative period and then started to show varying degrees of agitation scores increasing toward the end of the first 24 hours postoperatively.
As regard postoperative side effects, Five out of sixty patient developed vomiting, one patient in control group and four patients in nalbuphine group. Four out of sixty patients developed itching (one patient in nalbuphine group and three patients in fentanyl group). Only one patient developed urinary retention and that was in nalbuphine group. None of patients in our study developed respiratory depression at any time in the postoperative 24 hour.
Conclusion
The current study showed that single shot caudal block adding nalbuphine 0.2 mg /kg to bupivacaine 0.125 % provides better postoperative pain control than adding fentanyl g to bupivacaine in the same concentration with comparable incidence of adverse effects
Limitation of the study
Alarger sample size of patients can be further assessed for occurrence of side effects to be more accurate and conclusive