Kim Soo Hwan, Chun Duk-Hee, Chang Chul Ho, Kim Tae Wan, Kim Young Mi, Shin Yang-Sik
Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Paediatr Anaesth. 2011 Apr;21(4):394-8. doi: 10.1111/j.1460-9592.2011.03530.x. Epub 2011 Feb 8.
Caudal block is a widely used technique for providing perioperative pain management in children. In this randomized double-blinded study, we evaluated the effects of preoperative caudal block on sevoflurane requirements in children with cerebral palsy (CP) undergoing lower limb surgery while bispectral index (BIS) values were maintained between 45 and 55.
52 children undergoing Achilles-tendon lengthening were randomized to receive combined general-caudal anesthesia (caudal group, n = 27) or general anesthesia alone (control group, n = 25). Caudal block was performed with a single dose of 0.7 ml·kg(-1) of 1.0% lidocaine containing epinephrine at 5 μg·ml(-1). The control group received no preoperative caudal block. The endtidal sevoflurane concentrations (ET(sev)) were adjusted every minute to maintain the BIS values between 45 and 55.
The ET(sev) required to maintain the BIS values were not significantly different between the control and caudal groups after induction of anesthesia [2.1 (0.2) vs 2.2 (0.4); P = 0.773]. However, significantly higher ET(sev) was observed in the control group before surgical incision [2.0 (0.2) vs 1.8 (0.3); P = 0.013] and during the first 20 min after surgical incision [2.2 (0.3) vs 1.4 (0.3); P < 0.001]. There was no significant difference in BIS values between the control and caudal groups throughout the study period (P > 0.05). In the caudal group, the caudal block was successful in 25 of 27 (92.6%) patients.
Caudal block effectively reduced sevoflurane requirements by 36% compared to general anesthesia alone in children with CP undergoing lower limb surgery while BIS values were maintained between 45 and 55.
骶管阻滞是一种广泛应用于儿童围手术期疼痛管理的技术。在这项随机双盲研究中，我们评估了术前骶管阻滞对接受下肢手术的脑瘫（CP）患儿七氟醚需求量的影响，同时将脑电双频指数（BIS）值维持在45至55之间。
52例接受跟腱延长术的患儿被随机分为接受全身 - 骶管联合麻醉（骶管组，n = 27）或单纯全身麻醉（对照组，n = 25）。骶管阻滞采用单剂量0.7 ml·kg(-1)的含肾上腺素5 μg·ml(-1)的1.0%利多卡因进行。对照组未进行术前骶管阻滞。每分钟调整呼气末七氟醚浓度（ET(sev)）以维持BIS值在45至55之间。
麻醉诱导后，对照组和骶管组维持BIS值所需的ET(sev)无显著差异[2.1(0.2) vs 2.2(0.4); P = 0.773]。然而，在手术切口前对照组的ET(sev)显著更高[2.0(0.2) vs 1.8(0.3); P = 0.013]，且在手术切口后的前20分钟内也更高[2.2(0.3) vs 1.4(0.3); P < 0.001]。在整个研究期间，对照组和骶管组的BIS值无显著差异（P > 0.05）。在骶管组，27例患者中有25例（92.6%）骶管阻滞成功。
在接受下肢手术且BIS值维持在45至55之间的CP患儿中，与单纯全身麻醉相比，骶管阻滞可有效降低36%的七氟醚需求量。
