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Title - Role of caudal epidural block in Paediatric surgical patients.

Authors- Dr. Sarita Singh, Dr.V.K Bhatia , Dr. J.D.Rawat Department of Anesthesiology King
Georges Medical University Lucknow UP India.

Introduction Caudal block is a regional technique that is used with the greatest frequency in paediatric
patients , It was first described in 1933 but it gain popularity only in the early 1960. Caudal epidural block
can be in combination with general anaesthesia or alone provide Safe reliable and efficient analgesia and
anaesthesia for patients undergoing lower abdominal surgery.
Aim and objective of study 1. To know the quality, duration of analgesia and with and without
(Bupivacaine) and B Bupivacaine and Tramadal combination side effect of these two drugs.
Materials and Methods The above study were in done in department anaesthesialogy King Georges
Medical University Lucknow U.P India from January 2013 to December 2013 (duration 1year). Twenty
four children aged between 1-5yrs, weighing between 7-18 Kg and of ASA I and II physiologic status were
enrolled for the study. These patients were scheduled general anaesthesia and surgery by a single surgeon.
The patients were randomly allocated in two groups. Any children having allergy to bupivacaine or
Tramadol to were excluded from the study.Group A received single shot caudal block with 0.25%
bupivacaine 0.5ml.kg1 and Group B received 0.25% bupivacaine 0. 5ml.kg1 plus tramadol 2mg.kg1. After
induction, caudal block was given in right lateral position by a 22G needle under aseptic condition.
Syringes containing an equal volume of either 0.25% bupivacaine 0.5m1.kg1 or 0.25% bupivacaine
0.5ml.kg1 plus tramadol 2mg.kg1 were prepared and given to the investigator who was blinded to the
identity of drug(s). Intraoperative heart rate, temperature respiratory rate, blood pressure (NIBP) and oxygen
saturation (SpO2) was monitored. After recovery from general anaesthesia the patient was shifted to post
operative ward and his vitals pain score and side effect was assessed regularly, difference hours till 24 hours.
Results The two groups were comparable in age, weight duration of anaesthesia and duration of surgery
While comparing the quality of postoperative analgesia between the two groups it was seen that the Group A
started having mild pain after 3hrs and the pain was significant after 6hrs whereas in Group B the child was
pain free for almost 5 hrs and started having significant pain after 8 hrs which needed analgesic
supplementation with syrup Paracetamol at the dose of 10 mg.kg1. Significant pain is described as one that
has a pain score of more than 3. When pain score was plotted against time in a graph, it was seen that the
score was 0 upto 2 hrs and then started to increase and reached a score of 3 only after 8 hrs in Group B,
where as in Group A the pain score started to attain 3 after 6 hrs.The vitals of patients in both groups remain
stable during operation and post operative period till 24 hours. Nausea and vomiting was slightly more in
Group B than Group A no other complication and mortality noted in any group. .
Conclusion Our study concluded that caudal administration of bupivacaine along with tramadol
significantly increased the duration and quality of postoperative analgesia with children undergoing lower
abdominal surgery without producing significant adverse effects.