Purnima Narasimhan1, Lokesh Kashyap2, V K Mohan1, Mahesh Kumar Arora3, Dilip Shende1, Maddur Srinivas4, Seema Kashyap5, Sayan Nath1, Puneet Khanna1. 1. Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India. 2. Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India. Electronic address: lokeshkashyap@yahoo.com. 3. Department of Anaesthesia, Institute of Liver and Biliary Sciences, New Delhi, India. 4. Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India. 5. Department of Ocular Pathology, All India Institute of Medical Sciences, New Delhi, India.
Abstract
STUDY OBJECTIVE: This study was undertaken to compare the analgesic efficacy of ultrasound-guided single-shot caudal block with ultrasound-guided single-shot paravertebral block in children undergoing renal surgeries. DESIGN: Randomised, interventional, blinded clinical trial. SETTING: Operating rooms of All India Institute of Medical Sciences, New Delhi, India. PATIENTS: 50 children aged 2-10 years, of ASA status I/II, posted for elective renal surgeries. INTERVENTIONS: The children were randomised into two groups (Group C-caudal block, Group P-paravertebral block). After induction of general anesthesia, single-shot caudal or paravertebral block was performed under ultrasound guidance, with 0.2% ropivacaine with 1:200000 adrenaline. MEASUREMENTS: Time to first rescue analgesia, time to perform blocks, intraoperative and post-operative hemodynamics, post-operative FLACC scores, incidence of complications, parental satisfaction scores were recorded. MAIN RESULTS: Children in Group P had significantly longer duration of analgesia (p < 0.0004) than Group C. Post-operative FLACC scores (p < 0.005) and analgesic requirements (p < 0.0004) were lower in Group P. The mean fentanyl requirement over 24 h in group P was 0.56 ± 0.82 μg/kg, compared to 1.8 ± 1.2 μg/kg in group C. Parents in Group P reported greater satisfaction (p < 0.02). No complications were seen in either of the groups. CONCLUSION: This study showed superior analgesia and parental satisfaction with single-shot paravertebral block in comparison to single-shot caudal block for renal surgeries in children. However, the block performance in children requires adequate expertise and practice.
RCT Entities:
STUDY OBJECTIVE: This study was undertaken to compare the analgesic efficacy of ultrasound-guided single-shot caudal block with ultrasound-guided single-shot paravertebral block in children undergoing renal surgeries. DESIGN: Randomised, interventional, blinded clinical trial. SETTING: Operating rooms of All India Institute of Medical Sciences, New Delhi, India. PATIENTS: 50 children aged 2-10 years, of ASA status I/II, posted for elective renal surgeries. INTERVENTIONS: The children were randomised into two groups (Group C-caudal block, Group P-paravertebral block). After induction of general anesthesia, single-shot caudal or paravertebral block was performed under ultrasound guidance, with 0.2% ropivacaine with 1:200000 adrenaline. MEASUREMENTS: Time to first rescue analgesia, time to perform blocks, intraoperative and post-operative hemodynamics, post-operative FLACC scores, incidence of complications, parental satisfaction scores were recorded. MAIN RESULTS:Children in Group P had significantly longer duration of analgesia (p < 0.0004) than Group C. Post-operative FLACC scores (p < 0.005) and analgesic requirements (p < 0.0004) were lower in Group P. The mean fentanyl requirement over 24 h in group P was 0.56 ± 0.82 μg/kg, compared to 1.8 ± 1.2 μg/kg in group C. Parents in Group P reported greater satisfaction (p < 0.02). No complications were seen in either of the groups. CONCLUSION: This study showed superior analgesia and parental satisfaction with single-shot paravertebral block in comparison to single-shot caudal block for renal surgeries in children. However, the block performance in children requires adequate expertise and practice.