Comparison of Pre and Post Surgical Caudal Block in Reducing Stress Responses in Children

Objective: 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. Methodology: 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 1μg/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. Results: 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). Conclusions: In children, pre but not post surgical caudal block attenuates the stress response associated with lower abdominal surgery.