ABSTRACT
BACKGROUND@#Pain in the pediatric age is more difficult to assess and treat. Inadequate pain management may produce anxiety and trauma in children and affect not only the surgical outcome but the child‘s overall quality of life and recovery. Advances in various perioperative techniques to provide optimal analgesia continually grow especially in the outpatient setting where there are a significant number of pediatric patients. Caudal block is easy to perform and can be used in combination with general anesthesia. It provides excellent analgesia but is often short-lived. Dexamethasone is a potent synthetic glucocorticoid with anti-inflammatory and anti-emetic properties. The exact mechanism for its analgesic action is said to be related to its strong anti-inflammatory action.@*OBJECTIVES@#The study aims to determine and compare the anxiety of children with acute lymphoblastic leukemia (ALL) and their well siblings based on Child drawing: Hospital manual and to identify factors associated with the level of anxiety.@*METHODOLOGY@#This is a prospective, double-blind, randomized study that included sixty-four patients, aged 3 - 12 years old, ASA I and II, scheduled for outpatient urologic surgery under combined general and regional caudal anesthesia. Patients were randomized into two groups: Group D received 0.5mg/kg (maximum of 16mg) single dose intravenous dexamethasone in 5mL volume and Group P received the same volume of saline after the start of surgery when successful caudal block was determined. Postoperative pain scores using the Wong-Baker Faces Pain Rating Scale and vital signs were monitored at the PACU at hourly intervals until discharge. The time to first rescue analgesic and the total analgesic consumption given at home for forty-eight hours were recorded.@*RESULTS@#Group D showed significantly longer block duration and time to rescue analgesic and lesser analgesic consumption.@*CONCLUSION@#A single dose intravenous dexamethasone combined with caudal block effectively prolongs duration of caudal block and time to first rescue analgesic and lessens analgesic consumption in children undergoing outpatient urologic surgery.
ABSTRACT
@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Caudal epidural anesthesia is commonly performed in conjunction with general anesthesia. Bupivacaine and Levobupivacaine are used in epidural blockade that provide anesthesia and analgesia intraoperative and post-operatively.</p><p style="text-align: justify;"><strong>OBJECTIVES:</strong> To compare the intraoperative and postoperative efficacy and safety of Bupivacaine and Levobupivacaine in children undergoing elective sub-umbilical operations under general and caudal anesthesia.</p><p style="text-align: justify;"><strong>METHODS:</strong> Randomized control trial done in Philippine Children's Medical Center. Sixty-one subjects aged 6-months -8 years old, ASA I-II, undergoing subumbilical operations were randomly grouped to receive Bupivacaine and Levobupivacaine during anesthesia induction. Hemodynamic parameters, Bromage, and CHIPPS were recorded.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Results suggest both drugs have a significant effect in lowering heart rate and MAP. Bromage scores for patients from both groups are consistent at 0. The number of patients with a CHIPPS classification of 4-10, is significantly higher for bupivacaine group than levobupivacaine group.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Both Bupivacaine and Levobupivacaine provide adequate analgesia intraoperatively with no reports of intraoperative movement, increased inhalational agent concentration and additional intravenous analgesics. Post-operatively, no adverse effects and motor block was noted however Levobupivacaine has a longer efficacy as it required lesser rescue does post-operatively compared to Bupivacaine. </p>