Caudal versus spinal anesthesia in children undergoing lower abdominal operations

Abstract

Objective The aim of this study was to compare spinal and caudal anesthesia in children undergoing lower abdominal surgeries, as regards efficacy of anesthesia, hemodynamics, and postoperative pain. Background General anesthesia in pediatric patients, especially premature children, is one of the most important risk factors for postoperative apnea. Patients and methods The study was a randomized, double-blind, controlled trial. Totally, 40 children aged 3–12 years received either caudal or spinal anesthesia. The outcomes measured were hemodynamics, degree of motor block using Bromage score, pain assessment using Wong–Baker facial grimace scale, degree of sedation, total requirement of postoperative analgesia, complication rate, and parent satisfaction. Results A total of 40 children were included for analysis. Of them, 20 children received caudal and 20 received spinal anesthesia. Heart rate was significantly higher in the caudal group than in the spinal group (P = 0.006). The mean score measured using the Wong–Baker facial grimace scale for postoperative pain assessment at 2 h in the caudal group was 0.30 ± 0.47, compared with 5.05 ± 3.72 in the spinal group; there was a highly significant statistical difference (P = 0.00). The mean score measured using Bromage score at 90 min in the caudal group was 3.0 ± 0.00, compared with 2.75 ± 0.44 in the spinal group; there was a significant statistical difference (P = 0.021). There was no significant statistical difference between the two groups as regards blood pressure changes, oxygen saturation readings, sedation, and complication rate. Conclusion Both caudal and spinal approaches are effective in pediatric patients as anesthesia for lower abdominal operations. However, caudal anesthesia has a relatively longer duration of postoperative analgesia and motor block.