A Comparison of Two Different Doses of Bupivacaine in Caudal Anesthesia for Neonatal Circumcision: A Randomized Clinical Trial

Abstract

Background:We aimed to compare the analgesia quality of caudal block of low volume, high concentration bupivacaine to the conventionally used volumes and concentrations of the drug in neonates undergoing circumcision with sole caudal anesthesia.Methods: Fifty neonates, undergoing circumcision were randomly assigned to low volume high concentration (group LVHC, n=25) and control groups (group C, n=25). Both groups received a caudal injection: Group LVHC 0.5 ml/kg bupivacaine 0.375% (1.875 mg/kg) and group C 1 ml/ kg bupivacaine 0.25% (2.5 mg/kg). Hemodynamic parameters, block onsets and analgesia periods were compared among the groups. Pain scores were evaluated hourly for 3 hours postoperatively with NIPS (neonatal infant pain score). Statistical analyses were performed with Student's t-test for continuous variables. X 2 and Mann-Whitney U-tests were used for nominal and/or categorical variables.Results: Demographic, hemodynamic data, block onset time (group LVHC and C values were 4.9 ± 1 vs 5.2 ± 2 mins, respectively; p=0.53) was similar and postoperative median NIPS (a median value of 0 at postoperative 1, 2, and 3. hours) were identical among the groups (p=0.7, p=0.9, p=1). None of the neonates required additional analgesic for the first 24 hours following the surgery; therefore postoperative analgesic requirement was similar among the groups (p>0.1). Conclusions:Low volume high concentration caudal bupivacaine provided a similar perioperative analgesia quality, time and safety profile compared to conventional bupivacaine doses in awake neonates undergoing circumcision. Low volume, high concentration bupivacaine may be used to reduce the risk of local anesthetic toxicity in outpatient neonates.

Analgesia, nil or placebo to babies, in trials that test new analgesic treatments for procedural pain

“…Our search generated 45 studies and in 31 of these the source of pain was a routine heel prick or venepuncture. The other pain sources were two studies involving eye examinations; three involving endotracheal or nasal suctioning; three involving oro/nasogastric tube placement; and one each involving circumcision, intubation, transurethral catheterisation, hepatitis B vaccine injection, adhesive tape removal, arterial puncture and central vein catheterisation.…”

A cadaveric study to determine the minimum volume of methylene blue to completely color the nerves of brachial plexus in cats. An update in forelimb and shoulder surgeries

“…Additionally, it is possible that in the light of these lower concentrations, the effective blockade is related only to sensitive fibers in function of a more slender caliber in detriment the motor fibers, while still maintaining the analgesic quality 16 .…”

Our Experiences of Pre-emptive Analgesia in Pediatric Penile Surgery: A Retrospective Comparison of the Analgesic Effects of Caudal Block and Dorsal Penile Block

“…Bupivacaine is one of the most commonly used local anesthetics for caudal block and dorsal penile block and it is used in different doses and concentrations 9,10 . Adjuvant agents such as morphine, fentanyl, ketamine and neostigmine are widely used to improve the duration of effect and the quality of analgesia of the caudal block 6,11 .…”

“…However, in most studies, low complication rates have been reported for both caudal block and dorsal penile block, with no superiority of one over the other and it has been stated that both techniques could be used safely 3,4,13 . Some investigators have reported no complications or side effects in any patient who underwent caudal block 1,9,15 . Polat et al observed nausea and vomiting in 4 (14.8%) patients in the caudal block group, and in (3.3) patient in the penile block group5.…”