Effect of Caudal Epidural Analgesia on Postoperative Pain and Emergence Delirium in Children Undergoing Lower Abdominal Surgery: A Controlled Clinical Study

Abstract

Pediatric operation patients with lower abdominal surgery develop postoperative pain, emergence delirium (ED), which causes distress and prolonged recovery. Caudal epidural analgesia is a popular method of giving good pain relief, although its effects on the emergence delirium are still subject to research. The aim of this study was to determine the impact of caudal epidural analgesia on postoperative pain and emergence delirium in children undergoing lower abdominal surgery. A prospective controlled clinical trial was done at Hayat International Hospital, which involved 60 children aged 2-8 years (ASA I-II) who were electively undergoing infraumbilical surgeries. Patients were split into two categories, caudal group (n = 30) was administered with a single-shot caudal block containing 0.25% bupivacaine (1 ml/kg), and control group (n = 30) was administered systemic analgesia only. The FLACC scale was used to measure postoperative pain, and Pediatric Anesthesia Emergence Delirium (PAED) scale was used to measure emergence delirium. There was no significant difference in the baseline characteristics (p > 0.05). Caudal group showed much lower FLACC scores in all the postoperative times (p < 0.001). Emergence delirium scores were significantly reduced in the caudal group (7.4 ± 2.1 vs. 12.3 ± 3.2; p < 0.001), with a lower incidence of ED (20% vs. 50%; p = 0.01). Further, the caudal group needed less rescue analgesia and had a long time to first analgesic request (p < 0.001). Caudal epidural analgesia is superior to reduce the postoperative pain and emergence delirium in children that have lower abdominal surgeries. It also reduces analgesic needs and improves recovery and contributes to the regular use of this technique as an efficient element of multimodal anesthesia.