Presurgical caudal block attenuates stress response in children

ABSTRACT

Our aim was to determine if the anesthesia technique for pain relief in children affects-the stress response after minor surgery. A rise in blood glucose reflects stress-related effects in children who do not receive glucose preoperatively. Twenty-eight children, ages 17-81 mos, undergoing elective urologic procedures, were enrolled. For pain relief, patients received presurgical caudal block [group 1], intravenous narcotics [group 2], or postsurgical caudal block [group 3]. Blood samples were analyzed for glucose concentrations immediately after induction of anesthesia at baseline, 15 min after surgical incision [second sample], and 30 min after end of surgery [third sample]. In group 1 there was no change in glucose concentration in the second or third samples compared to baseline, while in group 3 there were significant increases in those samples, and in group 2 there was a significant increase in the second sample compared to baseline. Children in group 1 required significantly fewer narcotics in the post anesthesia care unit [PACU], and those in group 2 had significantly longer PACU and hospital durations. Presurgical caudal analgesia attenuates the stress response of anesthesia and surgery and decreases postoperative narcotic use while narcotics prolong PACU and discharge times