Assessing Caudal Block Concentrations of Bupivacaine With and Without the Addition of Intravenous Fentanyl on Postoperative Outcomes in Pediatric Patients: A Retrospective Review.
Caudal blocks are a significant and efficacious aspect of pediatric anesthesia, especially in urologic and many general surgery cases. This type of regional anesthesia is common because it has a high success rate and provides between 6 and 8 hours of postoperative pain control. The aim of this study was to determine whether the concentration of bupivacaine or the addition of intravascular (i.v.) fentanyl affected the postanesthesia care unit (PACU) discharge time. A retrospective cohort study comparing the outcomes in pediatric patients who have received varying caudal concentrations with and without the addition of i.v. fentanyl was performed. A total of 849 consecutive patients undergoing hypospadias repairs or circumcisions were reviewed and placed in one of the following 3 groups: 0.125% bupivacaine (group 1), 0.25% bupivacaine (group 2), or one of these concentrations of bupivacaine + i.v. fentanyl intraoperatively (group 3). Total PACU time for each group was 46.1 minutes (group 1), 48.9 minutes (group 2), and 49.7 minutes (group 3). Our results revealed that there is no statistically significant difference between concentrations of bupivacaine administered in a caudal block with or without i.v. fentanyl with regard to the outcome of PACU duration (P = 0.16). Overall, based on the retrospective cohort design, there is no difference in primary and secondary outcomes based on the concentration of bupivacaine, when administered at a volume of 1 mL/kg.
1Division of Pediatric Anesthesiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR; and 2Clinical Research Consultant, Little Rock, AR.
Megha M
MM
Karkera
Dale R
DR
Harrison
Jennifer P
JP
Aunspaugh
Timothy W
TW
Martin
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage* / Q000627:therapeutic use; D061605:Administration, Intravenous; D000763:Anesthesia, Caudal / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male; D004341:Drug Evaluation; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007021:Hypospadias / Q000601:surgery; D007223:Infant; D007268:Injections, Epidural; D008297:Male; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome
D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine