A randomized trial of caudal block with bupivacaine 4 mg x kg-1 (1.8 ml x kg-1) plus morphine (150 microg x kg-1) vs general anaesthesia with fentanyl for cardiac surgery.
BACKGROUND
Regional anaesthesia has been used effectively in paediatric patients undergoing cardiac surgery and is thought to be safe.


METHODS
Thirty patients ASA physical status II-III undergoing scheduled palliative or corrective cardiac surgery, receiving premedication with midazolam and anaesthetic induction with sevoflurane, fentanyl and pancuronium were randomly allocated to two groups. In group 1, patients received bupivacaine 0.22% 4 mg.kg-1 (1.8 ml.kg-1) and morphine 150 microg x kg-1 by the caudal route. After a 20-min period for the block to take effect, sevoflurane 0.5-1.0% and fentanyl 5 microg x kg-1 were administered for maintenance of anaesthesia. In group 2, the anaesthetic technique was the same as in group 1, without a caudal block and fentanyl 25 microg x kg-1 was administered at the moment of surgical incision.


RESULTS
Cardiovascular and haemodynamic responses of patients receiving caudal block showed minor variations during the 20-min period between caudal and general anaesthesia. Fentanyl requirements during surgery were lower (P = 0.001) in patients with caudal block than patients with general anaesthesia. Extubation time was shorter (P = 0.034) in the caudal group. Two patients in the general anaesthesia group and one in the caudal group died because of postoperative complications.


CONCLUSIONS
Caudal block with bupivacaine 0.22% 4 mg.kg-1 (1.8 ml.kg-1) and morphine 150 microg x kg-1 was safe and effective for paediatric patients undergoing cardiac surgery. However, patients might have a better outcome with a reduction of morphine dosage and administration of a muscle relaxant of shorter duration of action than pancuronium.
Rojas-Pérez
Eduardo
E
Department of Anaesthesia, Instituto Nacional de Cardiología Ignacio Chávez, México DF.
Castillo-Zamora
Carlos
C
Nava-Ocampo
Alejandro A
AA
D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000763:Anesthesia, Caudal / Q000706:statistics & numerical data*; D000768:Anesthesia, General / Q000706:statistics & numerical data*; D019162:Anesthetics, Combined / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures; D002319:Cardiovascular System / Q000187:drug effects; D002675:Child, Preschool; D005283:Fentanyl / Q000627:therapeutic use*; D006331:Heart Diseases / Q000601:surgery*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007223:Infant; D009020:Morphine / Q000627:therapeutic use*; D011446:Prospective Studies; D013997:Time Factors
D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D009020:Morphine; D005283:Fentanyl; D002045:Bupivacaine