Evaluation of the analgesic effect of caudal anesthesia in pediatric lower extremity orthopedic surgery

INTRODUCTION: The aim of this study is to evaluate the preoperative and postoperative effects of caudal analgesia in pediatric orthopedic lower extremity surgery.
METHODS: A total of 92 children who underwent orthopedic lower extremity surgery under general anesthesia were retrospectively included in the study. For caudal analgesia, 0.5 ml/kg 0.25% levobupivacaine and 20 mcg/kg morphine were used as our routine. The effect of caudal analgesia on hemodynamic parameters (heart rate, mean arterial pressure), oxygen saturation, sevoflurane concentration and procedural success rates using objective pain scale scores (OPS) were evaluated.
RESULTS: The mean age of the patients was 5.6±3.7 (1-13) years, and 54.3% of them were male. The mean operation time was 100±94 minutes. Caudal block suppressed the response to the surgical incision, and caused a decrease in heart rate, mean arterial pressure, and sevoflurane values (p <0.05). The OPS’s were found to be >4 in 8.7% of the patients, and in these patients’ caudal block was considered to be unsuccessful for achieving a satisfactory analgesic effect. The mean time to the first analgesic administration to the patients was 526 ± 242 (85-1110) minutes after caudal analgesia. In the first 24 hours, 40.2% of the patients did not need additional analgesics.
DISCUSSION AND CONCLUSION: Caudal block is an anesthesia technique with high success rate, easy application, and low complication rate. In addition, it can provide long-term analgesia both perioperatively and postoperatively in pediatric patients undergoing orthopedic lower extremity surgery with a single injection technique.