Application Of Continuous Epidural Block Through Sacral Canal For Postoperative Analgesia In Pediatric With Abdominal And Perineal Surgery

Objectives To explore the safety and efficacy of continuous epidural block through sacral canal application to postoperative analgesia in pediatric.Methods Eighty-four patients(ASA ?~?,1~5 years old)of abdominal and perineal surgery were randomly divided into three groups,each group 28 cases.Control group: general anesthesia group;group S: general anesthesia combined single caudal block;group E: given continuous epidural block through sacral canal under general anesthesia,and used patient controlled epidural analgesia.After premedication with midazolam(0.1mg/kg i.v.),three groups of children was induced with intravenous general anesthesia,and maintained with intravenous and sevoflurane in oxygen/air.After induction,group S patients received a single caudal blockade either with ropivacaine 0.25% at 0.8 ml/kg;group E were inserted an epidural catheter introduced via sacral hiatus.While epidural catheters were inserted into the level of L2~L3(abdominal surgery),or the level of L5~S1(anus or rectal surgery),or the level of S2 ~S3(urethral surgery)in group E.After determined the catheter without blood andcerebrospinal fluid backflow,injected 2 ml of 1% lidocaine as a test dose,without signs of subarachnoid block after 5 min and patient vital signs were stable,then injected 0.25% ropivacaine at one third or quarter of the full dose(the full dose was 0.8 ml/kg).Three groups according to the vital sign changes and patients conditions to adjust intravenous anesthetics injection speed and concentration of sevoflurane or supplement analgesic.Group E were injected one third or quarter of the ropivacaine full dose per hour and used patient controlled epidural analgesia within 48 hours after the surgery.All the children's general situation,the duration of operative,postoperative fasting time and hospitalization duration were recorded.FLACC score was used to assess the postoperative pain intensity at 1h(T1),4h(T2),8h(T3),12h(T4),24h(T5),36h(T6),48h(T7),72h(T8)after operation,Ramsay sedation score and heart rate were also recorded.Recorded the number of children used postoperative analgesics and sedatives within 72 hours after operation and time of delivering drugs.Parents' Postoperative Pain Measure score at the second day after surgery,and postoperative adverse reactions(such as fever,vomiting,respiratory depression,itchy skin,and toxic reaction)and complications(nerve damage,local or intraspinal infection)within 72 hours after operation were also noted.Results Finally 72 patients were selected to our study,which there were 23 cases in control group,24 cases in group S and 25 cases in group E.(1)Three groups of children in general situation,type of operation,the duration of operative,postoperative fasting time and hospitalization duration had no significant difference(P > 0.05).(2)The Parents' Postoperative Pain Measure score in group S and group E were significant higher than those in control group,those score were also higher in group E than in group S(P<0.05).(3)FLACC score at each observation point were significant lower in group S and group Ethan in control group,and those score in group E were significant lower than in group S(P < 0.05).The comparison of Ramsay sedation score at each observation point in three groups were not statistically significant(P>0.05).(4)Compared with group S and control group,the number of patient needing additional analgesia within 72 hours after operation in group E were significant decreased(P<0.05).Patients in group S and group E were not added analgesia in 0~4 h period after surgery,while there were 4 patients added analgesia in control group.The time of using additional analgesia for the first time were obviously postponed.The number of children needed postoperative sedatives and times of delivering had no significant differences in three groups(P>0.05).The incidence of postoperative adverse reactions in the first three days after surgery in three groups had no significant difference(P>0.05).There were no complications such as nerve injury,local or intraspinal infection in the three groups.Conclusions(1)Continuous epidural block through sacral canal can provide continuous and effective analgesia for children with abdominal and perineal surgery.0.1% ropivacaine combined with 1?g/ml fentanyl in continuous epidural block through sacral canal for postoperative analgesia in pediatric can achieve satisfactory results.(2)Single caudal block can provided good pain control in children of 4 ~ 6h after abdominal and perineal operation.