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Review paper

Caudal block with analgosedation – a superior anaesthesia technique for lower abdominal surgery in paediatric population

By
Adisa Šabanović Adilović Orcid logo ,
Adisa Šabanović Adilović
Contact Adisa Šabanović Adilović

Department of Anaesthesiology and Intensive Care Unit, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina

Nermina Rizvanović ,
Nermina Rizvanović

Department of Anaesthesiology and Intensive Care Unit, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina

Harun Adilović ,
Harun Adilović

Department of Internal Medicine, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina

Malik Ejubović ,
Malik Ejubović

Department of Internal Medicine, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina

Azur Jakić ,
Azur Jakić

Department of Paediatric Surgery, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina

Hajrija Maksić ,
Hajrija Maksić

Pediatric Clinic, University Clinic Centre Sarajevo, Sarajevo, Bosnia and Herzegovina

Dušica Simić
Dušica Simić

Department of Paediatric Anaesthesia and Intensive Care, University Children’ s Hospital Belgrade, Belgrade, Serbia

Abstract

Aim
To compare intraoperative hemodynamic and respiratory stability and postoperative emergence delirium between two anaesthesia regimens in children (caudal block with intravenous continuous analgosedation versus general endotracheal anaesthesia) and intensity of postoperative pain and quality of postoperative analgesia.
Method
Forty children aged 2-6 years who underwent lower abdominal surgery were randomized depending on performed anaesthesia into two groups: caudal block with analgosedation (group CB) and general endotracheal anaesthesia (group GA). Intraoperative hemodynamic and respiratory stability were evaluated measuring systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), heart rate (HR) and arterial oxygen saturation (SaO 2) in preinduction (t 0), at the moment of surgical incision (t 1), 10 minutes after surgical incision (t 2) and at the time of skin suturing (t 3). Postoperative emergence delirium was evaluated using Paediatric Anaesthesia Emergence Delirium score (PAED). Postoperative pain was evaluated by Children's and Infants' Postoperative Pain score (CHIPPS). Both scores were recorded every 5 minutes during first half hour postoperatively, additionally after 60 minutes postoperatively for CHIPPS score.
Results
SBP, DBP and MAP were lower at t 1 (p<0.0001), t 2 (p<0.05) and t 3 (p<0.001) in the group CB. HR was lower at all studied time points (p<0.005) in the group CB. SaO 2 was lower in the CB group but comparable with the GA group. PAED and CHIPPS scores were lower at 5, 10, 15, 20 and 25 minutes postoperatively (p<0.001) in the CB group. Conclusion
Caudal block with analgosedation provides better control of intraoperative hemodynamic conditions, postoperative emergence delirium and postoperative pain than general endotracheal anaesthesia.

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