Effect of Caudal Block on Minimum Alveolar Concentration (MAC) of Inhalational Anesthetic and Recovery in Pediatric Age Group for Inguinal Hernia Repair

Sarhan, Hasan; Abdullah, Ahmed Saeed; Saleem, Manal Behnam

	Effect of Caudal Block on Minimum Alveolar Concentration (MAC) of Inhalational Anesthetic and Recovery in Pediatric Age Group for Inguinal Hernia Repair
Iraqi Postgraduate Medical Journal
Article 1, Volume 15, Issue 2, 2016, Pages 251-258 PDF (458.09 K)
Authors
Hasan Sarhan; Ahmed Saeed Abdullah; Manal Behnam Saleem
Abstract
BACKGROUND: Caudal block is the commonest regional technique in pediatric patients. It provides excellent analgesia with minimal side effects. It is typically combined with general anesthesia. There are a number of advantages to this practice because anesthetic depth can be reduced by regional anesthesia, thereby potentially reducing the complications of both forms of anesthesia. It is commonly used for procedures below the umbilicus. OBJECTIVE: The aim of the study is to evaluate the effect of caudal block in reducing the anesthetic requirement when it is combined with general anesthesia and its effect on the recovery period. PATIENTS AND METHOD: Forty healthy unpremedicated children, ASA Ӏ, aged (2-5 years) undergoing inguinal hernia repair, were randomized to either Caudal group [using 1ml/kg of 0.25% bupivacaine] (n=20), or control group ( without caudal block) (n=20). In both groups anesthesia were induced and maintained with halothane, the vital signs were recorded ( heart rate, respiratory rate) every 5 minutes, and according to stability of the vital signs the inspired halothane concentration was followed. We also compared the recovery in both groups. RESULTS: At surgical incision; in group 0 [ control], there were increases in heart rates [15-20%] and in respiratory rates [6-8%] from zero time, while in group1 [caudal], the heart rates increased only by [ 2-3%] and respiratory rates by [1-2%]. After 15 min. from zero time, the vital signs remained around the zero time in group 0; while in group 1 the vital signs decreased below the zero time by [13-14%]. At 30 minutes there was further fall in the vital signs in group1 [16%], so we decreased inspired halothane concentration to 0.6 till the end of surgery. In group 0, the measurements remained around the zero time or just slightly changed [less than 5%], while inspired halothane concentration remained at 1.1% till the end of surgery. The recovery in group1 was smoother and faster than in group 0 with lesser complications . CONCLUSION: Caudal block using 1ml/kg of 0.25% bupivacaine, when combined with general anesthesia for inguinal herniotomy in pediatric age group, is sufficient to reduce the halothane requirement [MAC] intraoperatively and insures smoother and faster recovery without any major airway-related complications or hemodynamic instability.
Keywords
caudal block; general anesthesia; lower abdominal surgery; pediatric age group.

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