title: Caudal epidural block for analgesia following herniorrhaphy with laparoscopy in children.
abstract: This study prospectively evaluated the efficacy of caudal epidural block in providing analgesia following inguinal herniorrhaphy and laparoscopy. Laparoscopy was used only to inspect the contralateral side to determine if a second hernia was present. No surgical manipulation was performed through the telescope. Following mask induction with halothane in nitrous oxide and oxygen, a caudal epidural block was performed with 1.2 mL/kg of 0.25% bupivacaine. Pain scores were obtained at four points during the in-hospital postoperative course, and the need for supplemental analgesic agents was assessed. A total of 45 patients were studied. Caudal epidural block could not be performed in 1 patient, and this patient was excluded from further consideration. There were 34 boys and 10 girls, ranging in age from 2 to 84 months (mean +/- SD 37.4 +/- 18.2 months) and weighing from 3.4 to 34 kg (mean +/- SD 14.2 +/- 5.8 kg). Thirty-six of 44 patients (82%) did not require supplemental analgesic agents during their in-hospital postoperative course and had pain scores of 2 or less at all four evaluation points. Six of 8 patients required a single dose of intravenous fentanyl (0.5 microgram/kg) to maintain scores of 2 or less. No significant complications related to caudal epidural block were noted in any patient. Caudal epidural block provides effective analgesia following inguinal herniorrhaphy and laparoscopy in children.
authors.affiliation: Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee.
authors.forename: J D
authors.initials: JD
authors.lastname: Tobias
authors.forename: G W
authors.initials: GW
authors.lastname: Holcomb
authors.forename: S
authors.initials: S
authors.lastname: Lowe
authors.forename: S
authors.initials: S
authors.lastname: Hersey
authors.forename: J W
authors.initials: JW
authors.lastname: Brock
mesh_terms: D015360:Analgesia, Epidural; D002045:Bupivacaine; D002675:Child, Preschool; D005260:Female; D006552:Hernia, Inguinal / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D010535:Laparoscopy; D008297:Male; D009407:Nerve Block; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies
chemical_list: D002045:Bupivacaine