title: Does adding intravenous fentanyl to caudal block in children enhance the efficacy of multimodal analgesia as reflected in the plasma level of catecholamines?
abstract: OBJECTIVE
  Several studies showed that single analgesic modality management can attenuate perioperative stress, but little is known about the effect of multimodal analgesia on catecholamine responses to surgical trauma in children.
  
  
  METHODS
  Fifty children (American Society of Anesthesiologists Grade I or II) were randomly allocated to one of two groups: one received general anaesthesia and a caudal block (control group), and one group was given general anaesthesia, caudal block and intravenous (i.v.) fentanyl 2 microg kg(-1) (fentanyl group). Plasma epinephrine and norepinephrine concentrations were measured three times during the perioperative period: at induction time (T(0)), at the end of surgery (T(1)) and when the children were fully awake in the postanaesthesia care unit (T(2)).
  
  
  RESULTS
  There was a significant reduction in the catecholamine levels in the two groups when (T(1)) and (T(2)) were compared with T(0). When plasma epinephrine levels (at T(0), T(1) and T(2)) between the two groups were compared, a statistically significant reduction at T(2) was obtained in the fentanyl group, when compared with the control group. However, plasma norepinephrine levels showed no statistically significant difference between the two groups (at T(0), T(1) and T(2)).
  
  
  CONCLUSIONS
  These findings suggest that the multimodal analgesic approach of adding i.v. low-dose fentanyl to a caudal block may decrease the plasma epinephrine release in children undergoing inguinal herniotomy.
authors.affiliation: Technion - Israel Institute of Technology, Bruce Rappaport Faculty of Medicine, Anaesthesiology Department, Bnai-Zion Medical Center, Haifa, Israel. somri_m@yahoo.com
authors.forename: M
authors.initials: M
authors.lastname: Somri
authors.forename: R
authors.initials: R
authors.lastname: Tome
authors.forename: C B
authors.initials: CB
authors.lastname: Teszler
authors.forename: S J
authors.initials: SJ
authors.lastname: Vaida
authors.forename: J
authors.initials: J
authors.lastname: Mogilner
authors.forename: A
authors.initials: A
authors.lastname: Shneeifi
authors.forename: L
authors.initials: L
authors.lastname: Nurit
authors.forename: G
authors.initials: G
authors.lastname: Avital
authors.forename: O
authors.initials: O
authors.lastname: Zinder
authors.forename: L A
authors.initials: LA
authors.lastname: Gaitini
mesh_terms: D000698:Analgesia / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods; D019162:Anesthetics, Combined / Q000008:administration & dosage / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002245:Carbon Dioxide / Q000097:blood; D002395:Catecholamines / Q000097:blood*; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D017558:Elective Surgical Procedures / Q000379:methods; D004837:Epinephrine / Q000097:blood; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D006339:Heart Rate / Q000187:drug effects; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods; D009407:Nerve Block / Q000379:methods*; D009638:Norepinephrine / Q000097:blood; D016896:Treatment Outcome
chemical_list: D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D002395:Catecholamines; D002245:Carbon Dioxide; D005283:Fentanyl; D009638:Norepinephrine; D004837:Epinephrine