Monitoring intraoperative effectiveness of caudal analgesia through skin temperature variation

Abstract

Background/Purpose: A reliable noninvasive intraoperative marker of caudal analgesia effectiveness remains elusive. Caudal analgesia causes sympathetic inhibition resulting in vasodilatation, increased blood flow, and a resultant increase in temperature in the affected dermatomes. The authors hypothesize that this change in temperature between the affected and unaffected dermatomes is measurable and may represent a noninvasive method of monitoring effectiveness of caudal analgesia. Methods: Children undergoing lower abdominal surgery participated in the caudal or noncaudal (control) analgesia arm of the study. After induction of general anesthesia, 0.25% bupivicaine (1 mL/kg) was infiltrated for a field block in control patients or a caudal block in the experimental group. Temperature was measured at the C4 and L2 dermatomes starting after induction and 5 minutes before the caudal or field block and every 5 minutes after. To is defined as the difference between the C4 and L2. Delta T (ΔT) is the temperature variation between To. A change in the ΔT is defined by an increase in the L2 temperature. Results: Forty-six families enrolled (36 experimental, 10 control). The ΔT for controls was 0.2+/−0.09 °C (SEM). Each child in the experimental group had 2 temperature measurements before the caudal with an average ΔT of 0.3+/−0.07°C (SEM), thus, were internal controls. A marked increase in ΔT at 5 minutes 0.5+/−0.06°C (SEM) and at 10 minutes 0.6+/−0.07°C (SEM; P <.05) was noted in the experimental group. Conclusion: A significant transient change in temperature is observed after caudal analgesia and maybe a noninvasive marker of effectiveness. Further study may clarify its clinical utility. J Pediatr Surg 38:386-389. Copyright 2003, Elsevier Science (USA). All rights reserved.