Presurgical caudal block attenuates stress response in children

Background - Our aim was to determine if the anesthesia technique for pain relief in children affects the stress response after minor surgery. A rise in blood glucose reflects stress-related effects in children who do not receive glucose perioperatively. Methods - Twenty-eight children, ages 17-81 mos, undergoing elective urologic procedures, were enrolled. For pain relief, patients received presurgical caudal block (group 1), intravenous narcotics (group 2), or postsurgical caudal block (group 3). Blood samples were analyzed for glucose concentrations immediately after induction of anesthesia at baseline, 15 min after surgical incision (second sample), and 30 min after end of surgery (third sample). Results - In group 1 there was no change in glucose concentration in the second or third samples compared to baseline, while in group 3 there were significant increases in those samples, and in group 2 there was a significant increase in the second sample compared to baseline. Children in group 1 required significantly fewer narcotics in the postanesthesia care unit (PACU), and those in group 2 had significantly longer PACU and hospital durations. Conclusions - Presurgical caudal analgesia attenuates the stress response of anesthesia and surgery and decreases postoperative narcotic use while narcoltics prolong PACU and discharge times.