Preoperative caudal block prevents emergence agitation in children following sevoflurane anesthesia.
BACKGROUND
The frequency of emergence agitation in children is increased following sevoflurane anesthesia. However, controversies still exist concerning the exact etiology of this postanesthetic problem. Although this phenomenon is present with adequate pain relief or even following pain-free procedures, pain is still regarded as a major contributing factor.


METHODS
In a prospective, randomized, double-blind study, we enrolled 48 premedicated and calm 2-6-year-old children undergoing inguinal hernia repair. We assigned children to one of two groups: children assigned to the caudal group (n = 24) received a caudal block to supplement sevoflurane, while children assigned to the fentanyl group (n = 24) received a bolus injection of 1 microg kg(-1) intravenous fentanyl before skin incision to supplement sevoflurane. In the post anesthesia care unit, all children were received by their parent, and the incidence of emergence agitation and pain scores, as well as hemodynamic changes, were compared in both groups.


RESULTS
Forty-four children completed the study. In the fentanyl group, 59% of the children were agitated following emergence from anesthesia as compared to 4.5% in the caudal group (P < 0.001). Also, pain scores, mean values of heart rate and blood pressure as well as morphine requirement were significantly higher in the post anesthesia care unit in the fentanyl group compared to the caudal group.


CONCLUSIONS
Our results show that in children undergoing inguinal hernia repair, pain control with a preoperative caudal block as compared to intraoperative intravenous fentanyl significantly reduces the incidence of emergence agitation and pain scores following sevoflurane anesthesia.
Aouad
M T
MT
Department of Anesthesiology, American University of Beirut-Medical Center, Beirut, Lebanon. mm01@aub.edu.lb
Kanazi
G E
GE
Siddik-Sayyid
S M
SM
Gerges
F J
FJ
Rizk
L B
LB
Baraka
A S
AS
D000701:Analgesics, Opioid / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D000763:Anesthesia, Caudal / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000009:adverse effects* / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006439:Hemodynamics / Q000187:drug effects; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects* / Q000627:therapeutic use; D009020:Morphine / Q000627:therapeutic use; D010147:Pain Measurement / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000517:prevention & control*; D000077149:Sevoflurane; D013997:Time Factors
D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D009020:Morphine; D005283:Fentanyl