title: Caudal block with 4 mg x kg-1 (1.6 ml x kg-1) of bupivacaine 0.25% in children undergoing surgical correction of congenital pyloric stenosis.
abstract: BACKGROUND
  Since 1970, bupivacaine 0.25% in a dose of 4 mg x kg-1 (1.6 ml x kg-1) has been used at the Hospital Infantil de México for caudal block in children undergoing surgical correction of congenital pyloric stenosis (CPS). Although this dose is considered unsafe, in our experience, it has been associated with a high success rate and a low incidence of adverse events. This experience has not been previously documented.
  
  
  METHODS
  A retrospective cohort of patients undergoing surgical correction of CPS was studied. Nineteen patients received general anaesthesia while 223 received caudal block. The latter were then grouped according to the sedation technique. The rate of successful caudal blocks and complications were considered the major outcomes of the study, whereas the postsurgical fasting period and hospital stay were considered secondary outcomes.
  
  
  RESULTS
  The rate of success of caudal block was 96%. Anaesthetic complications related to bupivacaine were present in 1.3%. Mortality occurred in the postoperatory period in one septic patient who also was suffering from gastroschisis that required general anaesthesia. Postoperatory fasting period and hospital stay tended to be higher with general anaesthesia than caudal block. However, of the 19 patients receiving general anaesthesia, five suffered serious comorbidity and nine were failed caudal blocks.
  
  
  CONCLUSIONS
  Caudal block with bupivacaine 0.25% (4 mg x kg-1) was associated with a low rate of anaesthetic complications. Further prospective studies to clarify the risks and benefits are required.
authors.affiliation: Department of Anaesthesia and Respiratory Therapy, Hospital Infantil de México Federico Gómez, México. dianitamg@yahoo.com
authors.forename: Diana
authors.initials: D
authors.lastname: Moyao-García
authors.forename: Mercedes
authors.initials: M
authors.lastname: Garza-Leyva
authors.forename: Elvia Y
authors.initials: EY
authors.lastname: Velázquez-Armenta
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Nava-Ocampo
mesh_terms: D000763:Anesthesia, Caudal; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage* / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009407:Nerve Block; D011184:Postoperative Period; D011707:Pyloric Stenosis / Q000151:congenital / Q000188:drug therapy* / Q000601:surgery*; D012189:Retrospective Studies
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine