Caudal block for pain relief in children undergoing perineal and lower abdominal Surgeries at Muhimbili National Hospital Dar es salaam, Tanzania.

Abstract

Background Pain management is one of the important components of balanced anaesthesia. It can be provided by different methods intravenous, intramuscular, orally, topical or regional. Caudal block has evolved to become the most popular, safe and easy regional anaesthetic technique to be performed in children undergoing subumbilical surgeries. Objective The study was undertaken to assess the analgesic effect that is the duration and quality of analgesia provided by a single shot caudal epidural block using bupivacaine 0.25% for intraoperative and postoperative pain relief in children undergoing perineal and lower abdominal surgeries at Muhimbili National Hospital in Tanzania from April to December 2012. Material and methods After local ethical committee approval and obtaining informed parental consent, a cross sectional observational study was done in the main operating theatre and paediatrics surgery ward at Muhimbili National hospital from April to December 2012. A total of 118 ASA I and II children, aged 6months to 11years, undergoing perenial, genitourinary and lower abdominal surgeries, were enrolled in the study. All surgeries were done under general anaesthesia. Following induction caudal block was performed in the lateral position. Perioperative Cardio- respiratory parameters, analgesic requirement and complications were recorded in all children. Quality of pain during recovery was assessed by Flacc pain scale for 30 minutes interval with maximum of 2hours in the recovery room and then 2 hourly in the ward for 12hours. In the recovery room a child with score 1to 3paracetamol suppository (15mg/kg) was inserted while in the ward a child with a score of 4 or above rescue analgesia (injection morphine 0.1mg/kg) was given. Children were followed up for 24hours to identify and manage all detected complications. vi Results Caudal block was performed in 118 chidren with a success rate of (98.3%). The hemodynamic parameters were reduced or remained stable in all successful blocks. The hemodynamic alterations observed during the operation were statistically significant when compared to values before incision. (P<0.05). Average duration of analgesia was (8.20±2.1) hours with a range of 3-12hours. The duration of analgesia was prolonged in younger children when compared to those aged more than 72 months. Inguinal surgeries had a lower duration of analgesia when compared to other type of surgeries. FLACC pain score recorded at the time of rescue analgesia were not significantly different between different age groups or type of surgery p> 0.05. The Most common complication encountered was vomiting affecting 5% of 116 children, other complications rarely occurred. Conclusions This study has shown that caudal block success rate is high in providing intraoperative and postoperative analgesia. If there is no contraindication caudal block is the best choice analgesic technique in children undergoing subumbilical surgeries. Caudal block provide safe and effective intraoperative and post-operative analgesia with less hemonadynamic changes, complications and side effects. Recommendation Caudal epidural block should be part and parcel of paediatric anaesthetic management in children undergoing, genitourinary, perineal and lower abdominal surgeries in Tanzania.