Comparison of pre and post surgical caudal block in reducing stress responses in children

Surgical stress stimulates the release of catecholamine and cortisol. Both of which have anti-insulin action resulting in an increase of plasma glucose concentration. The most common regional block in pediatric age group is caudal epidural analgesia. The aim of this study was to compare the stress response following pre and post surgical caudal block. After approval by our local ethics committee and written parental consent 70 children between two and seven years of age scheduled for elective lower abdominal procedures were enrolled in this study. Anesthesia was induced with fentanyl 1micro g/kg, midazolam 0.03mg/kg, propofol 3mg/kg, LMA was inserted, maintenance was with halothane 1-1.5%, N2O 3 lit/min, O2 3 lit/min. Halothane concentration was decreased to 0.6% in children who received pre surgical caudal block [20 minutes after block]. Children in group-A received pre surgical caudal block with 0.25% bupivacain 1ml/kg, those in group B received post surgical caudal block with same dosage and concentration. Demographic data were similar. Plasma glucose concentration were decreased during the course of this study in Group A, [P = 0.045]. However, in Group B the plasma glucose level increase 15 min after beginning of surgery [P = 0.001]. The hemodynamic changes with in group A was less than group B [P < 0.05]. In children, pre but not post surgical caudal block attenuates the stress response associated with lower abdominal surgery

effect of small dose bupivacaine-fentanyl in spinal anesthesia on hemodynamic nausea and vomiting in cesarean section

To compare the hemodynamic, nausea and vomiting with small dose bupivacaine-fentanyl spinal anesthetic versus a conventional dose of spinal bupivacaine in parturients undergoing cesarean section. Forty patients aged 17-35 years old which underwent cesarean section were randomized into two groups. Group-A received spinal anesthesia with 8mg of bupivacaine and 10 micro g fentanyl, group B received 12mg bupivacaine. The mean dose of ephedrine needed was 4mg in group A and 11.75mg in group B [P=0.006]. The mean ratio of lowest systolic pressure to baseline systolic pressure was 0.75 for group A and 0.65 for group B [P=0.04]. Nausea and vomiting was observed in 10% of group A versus 20% in group B. Small dose of bupivacaine and Fentanyl provides good spinal anesthesia for cesarean section with less hypotension, nausea and vomiting