title: A study of the effect of caudal epidural block on bispectral index targeted propofol requirement in children: A comparative study.
abstract: Caudal epidural block is one of the most commonly performed neuraxial block techniques with reliable peri-operative and post-operative analgesia in pediatric patients. In our randomized, prospective, double-blinded, open level, parallel group study, we have established the effect of caudal epidural block on maintenance requirement of intravenous (IV) propofol in targeted bispectral (BIS) monitored patients.
  
  
  BACKGROUND
  Neuraxial anesthesia exhibits sedative properties that may reduce the requirement for general anesthesia. TIVA with propofol has been administered as an established method of maintaining general anesthesia in children. Caudal analgesia being a type of neuraxial block, also seems to reduce the requirement of sedative hypnotics in pediatric patients. Numerous studies show that for patients, administered with caudal epidural block, they require reduced intra-operative volatile inhalation anesthetics. In the present study, we have established the anesthetic sparing effect of Caudal Epidural Analgesia in children undergoing infra-umbilical surgical procedure and calculated the efficacy of propofol-infusion in maintaining adequate depth of anesthesia.
  
  
  OBJECTIVE
  (1) To study and compare the dose requirements of propofol using caudal epidural analgesia. (2) To calculate the efficacy of propofol as maintenance anesthetic agent in both groups and to compare hemodynamic stability of patients in both the techniques.
  
  
  METHODS
  In our study, after administering general anesthesia to pediatric patients, we have administered caudal analgesia and IV analgesia to monitor the requirement of intra-operative propofol infusion using BIS monitor with a target value of 40-60 in both groups.
  
  
  METHODS
  82 patients (aged between 3 and 6 years) have been selected undergoing infra-umbilical surgery and randomly allocated into two groups containing 41 patients in each group. Both the groups group B and group A then intubated with glycopyrrolate, 2 mg/kg injection fentanyl, propofol till loss of verbal contact and atracurium at the rate of 0.5 mg/kg and group B has been administered caudal epidural blockade with 1 ml/kg 0.2% ropivacaine. Propofol infusion at the rate of 10 mg/kg/h is given as maintenance. BIS value has been recorded throughout and propofol requirement at the end of surgery has been calculated.
  
  
  METHODS
  Numerical variables between groups have been analyzed using the Student's t-test and the Mann-Whitney U-test as applicable. Categorical variables have been analyzed using the Pearson's Chi-square test. P < 0.05 is considered statistically significant.
  
  
  RESULTS
  Consumption of propofol at the start of operation in the group A is 2.9 ± 0.17 and group B is 2.91 ± 0.17, which is not statistically significant (P > 0.05), whereas at the end of the operation in the group A is 11.33 ± 0.17 and group B is 7.83 ± 0.63, which is statistically significant (P < 0.05). Incidence of adverse effects is statistically insignificant between the two groups. The time for administration of rescue analgesic is 2.1 ± 0.88 in group A and 6.5 ± 0.17 in group B, which is statistically significant due to caudal analgesia.
  
  
  CONCLUSIONS
  We conclude that in BIS-monitored patients (3-6 years) with infra-umbilical surgeries have shown a reduction in consumption of IV propofol due to caudal epidural blockade.
authors.affiliation: Department of Anaesthesiology, NRS Medical College and Hospital, Kolkata, West Bengal, India.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Banerjee
authors.affiliation: Department of Anaesthesiology, NRS Medical College and Hospital, Kolkata, West Bengal, India.
authors.forename: Bibhukalyani
authors.initials: B
authors.lastname: Das
authors.affiliation: Department of Anaesthesiology, NRS Medical College and Hospital, Kolkata, West Bengal, India.
authors.forename: Dipankar
authors.initials: D
authors.lastname: Mukherjee
authors.affiliation: Department of Anaesthesiology, NRS Medical College and Hospital, Kolkata, West Bengal, India.
authors.forename: Moushumi
authors.initials: M
authors.lastname: Khanra
keywords: Anesthesia; bispectral index monitor; caudal; propofol
references.citation: Curr Opin Anaesthesiol. 2004 Jun;17(3):229-34
references.pmid: 17021556
references.citation: Br J Anaesth. 2004 Aug;93(2):228-34
references.pmid: 15220178
references.citation: Anesth Analg. 1995 Sep;81(3):525-8
references.pmid: 7653816
references.citation: Anesthesiology. 2009 Nov;111(5):1135-40
references.pmid: 19809281
references.citation: Korean J Anesthesiol. 2010 Jun;58(6):527-31
references.pmid: 20589176
references.citation: Jpn J Physiol. 1964 Aug 15;14:344-53
references.pmid: 14200815
references.citation: Reg Anesth. 1996 May-Jun;21(3):209-13
references.pmid: 8744662
references.citation: Anesthesiology. 1994 Feb;80(2):392-401
references.pmid: 8311321
references.citation: Anesthesiology. 2001 May;94(5):799-803
references.pmid: 11388531
references.citation: Acta Anaesthesiol Scand. 1998 Aug;42(7):845-50
references.pmid: 9698963
references.citation: J Clin Anesth. 1994 Nov-Dec;6(6):487-90
references.pmid: 7880512
references.citation: Anesthesiology. 1998 Apr;88(4):1036-42
references.pmid: 9579513
references.citation: Paediatr Anaesth. 2006 Aug;16(8):828-33
references.pmid: 16884465
references.citation: Acta Anaesthesiol Scand. 2005 Mar;49(3):300-4
references.pmid: 15752392
references.citation: Br J Anaesth. 2011 Feb;106(2):202-7
references.pmid: 21148173