Title

Outcomes of caudal block in children undergone lower umbilical surgeries at French Medical Institute for Mother and Child Health, Kabul, Afghanistan

Date of Award

1-2017

Document Type

Thesis

Degree Name

Diploma in Anaesthesiology

First Supervisor/Advisor

Ghulam Rasoul Rahimi

Second Supervisor/Advisor

Amena Shaheer

Department

French Medical Institute for Children (FMIC)

Abstract

Background: Pain management is one of the important components of balanced anaesthesia. It can be provided by different methods such as intravenous, intramuscular, orally, topical or regional. Caudal block has grown to become the most popular, safe and easy regional anaesthetic technique to be performed in children undergoing lower umbilical surgeries.
Objective: The study was conducted to assess the analgesic effect that is the duration and quality of analgesia provided by a single shot caudal epidural block using bupivacaine 0.25% for intraoperative and postoperative pain relief in children undergoing lower umbilical surgeries in FMIC Hospital, Afghanistan. The objective was to determine the success rate of Caudal Block among children undergone lower umbilical surgeries and received Caudal Block at French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan.
Methodology: A Retrospective Case Series study was done to achieve the study objectives. The study population was comprised of all the children undergone lower umbilical surgeries and received Caudal Block at French Medical Institute for Children (FMIC), Kabul, Afghanistan. Purposive sampling was utilized to recruit study subjects. Statistical Package for Social Sciences (SPSS) version 22.0 was used to run descriptive and inferential statistics. Chi-square test of independence was run to explore the association between independent and dependent variables.
Results: The present study revealed that the success rate of caudal block was 94.3%. All successful cases of caudal blocks were regarded as clinically effective. None of the patient had an increase in hemodynamic or respiratory parameters during surgery. Nearly all, 197 (99.5%) had successful caudal block. The participants had normal heart rate or slightly low HR (not more than 5 to 10 % from baseline HR) during anaesthesia and only 1 (0.5%) participant was bradycardia. Our results showed caudal block with single shot injection of 0.25% bupivacaine provided a long lasting analgesia. Caudal bupivacaine provided analgesia had a duration of equal or more than four hours. Majority of patient received pain killer (Nalbluphine) after four hour of caudal block. In our study, most of the patients, 194 (98%) patients had not experienced post anaesthesia side effects, whereas only 4 (2%) patients had post anaesthesia side effects (nausea or vomiting). None of the cases in our study required additional analgesics during operation.
Conclusion: Caudal block provided adequate intraoperative and postoperative analgesia for children under going lower umbilical surgeries with a success rate of 94.3%. Duration of analgesia demonstrated was equal to or more than four hours with only plane bupivacaine 0.25%. Hemodynamic parameters are stable perioperative and post operatively. All successful cases didn’t required additional analgesia during surgery. There were few side effects commonly nausea and vomiting which affected about 2% of the patients.

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