title: Effects of caudal sufentanil supplemented with levobupivacaine on blocking spermatic cord traction response in pediatric orchidopexy.
abstract: OBJECTIVE
  Caudal block is one of the most commonly used anesthetic techniques in subumbilical and genitourinary procedures. However, traditional administration of caudal levobupivacaine was inadequate on blocking peritoneal response during spermatic cord traction. The aim of this study was to evaluate whether the addition of caudal sufentanil to levobupivacaine provided better analgesia for children undergoing orchidopexy.
  
  
  METHODS
  Sixty-two patients, scheduled for right orchidopexy, received caudal block after induction. Group LS (n = 31) received levobupivacaine 0.25% 1 ml/kg plus sufentanil 0.5 μg/kg, and group L (n = 31) received levobupivacaine 0.25% 1 ml/kg only. HR or MAP fluctuation >20% or entropy increase >15% during spermatic cord traction was defined as inadequate anesthesia and was treated with increasing sevoflurane concentration. The number of children who needed sevoflurane rescue was counted, and postoperative side effects and quality of sleep were also recorded.
  
  
  RESULTS
  There were no statistically significant differences between the two groups in age, weight, and duration of surgery. Two (6.45%) children in group LS required inspired sevoflurane rescue to block hemodynamic fluctuation during spermatic cord traction, as compared with 12 (38.71%) patients in group L (P < 0.001). At the time of exerting spermatic cord traction, the median HR was, respectively, 134 and 145 (P < 0.001); the corresponding response entropy (RE) and state entropy (SE) was 65 and 54, respectively, in group LS versus 76 and 65 in group L (P < 0.001).
  
  
  CONCLUSIONS
  In pediatric orchidopexy, the addition of sufentanil to levobupivacaine for caudal blockade offers clinical benefit over levobupivacaine alone in blocking the spermatic cord traction response.
authors.affiliation: Department of Anesthesia, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Tingting
authors.initials: T
authors.lastname: Wang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Xiang
authors.forename: Feng
authors.initials: F
authors.lastname: Liu
authors.forename: Guanghui
authors.initials: G
authors.lastname: Wang
authors.forename: Yanxia
authors.initials: Y
authors.lastname: Liu
authors.forename: Liang
authors.initials: L
authors.lastname: Zhong
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage* / Q000009:adverse effects; D000763:Anesthesia, Caudal / Q000009:adverse effects / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D006801:Humans; D007223:Infant; D000077554:Levobupivacaine; D008297:Male; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods; D056126:Orchiopexy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D013085:Spermatic Cord / Q000187:drug effects* / Q000502:physiology / Q000601:surgery; D017409:Sufentanil / Q000008:administration & dosage* / Q000009:adverse effects; D014143:Traction / Q000379:methods; D014275:Trigeminal Caudal Nucleus / Q000187:drug effects*
chemical_list: D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D000077554:Levobupivacaine; D017409:Sufentanil; D002045:Bupivacaine