title: Caudal blockade shortens the time to walking exercise in elderly patients following low back surgery.
abstract: OBJECTIVE
  We conducted a randomized, double-blinded study to test our hypothesis that caudal blockade as preemptive analgesia for low back surgery might accelerate time to walking exercise following surgery and reduce postoperative analgesics, thereby attaining faster recovery of cognitive function.
  
  
  METHODS
  Our study included 51 elderly patients >70 years with American Society of Anesthesiologists (ASA) physical status 1-3, who underwent lumbosacral surgery under general anesthesia. After anesthetic induction and tracheal intubation, patients in the study group (group B) were injected with simple 0.5% bupivacaine [10 ml x height (m)] as a caudal block 15 min before surgical incision, whereas patients in the control group (group C) received normal saline. After surgery, patients had access to intravenous patient-administered analgesia (IV PCA), fentanyl, for postoperative pain relief. We assessed Mini-Mental State Examination (MMSE) scores before and after the surgery, values of visual analog scale (VAS) for postoperative analgesic status, fentanyl consumption during and for 3 days after surgery, and time to begin walking exercise after surgery.
  
  
  RESULTS
  VAS value of group B patients was significantly lower than those in group C throughout the postoperative 48-h period (p < 0.005), and group B patients began walking exercise significantly earlier than those in group C [mean +/- standard deviation (SD) 70.2 (14.3) in group C, and 61.9 (7.6) in group B; p = 0.0133]. Cognitive function level was higher in group B than in group C patients 24 h after operation.
  
  
  CONCLUSIONS
  Caudal blockade as preemptive analgesia shortened the time to start walking exercise after surgery and accelerated recovery of postoperative cognitive function.
authors.affiliation: Division of Operating Theatre, Tottori University Hospital, Tottori, Japan. masui@med.tottori-u.ac.jp
authors.forename: Masumi
authors.initials: M
authors.lastname: Kiribayashi
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Inagaki
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Nishimura
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Yamasaki
authors.forename: Shunsaku
authors.initials: S
authors.lastname: Takahashi
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Ueda
mesh_terms: D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000763:Anesthesia, Caudal / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D003071:Cognition / Q000187:drug effects; D004311:Double-Blind Method; D004434:Early Ambulation; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D010147:Pain Measurement; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine