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PEDIATRIC ANESTHESIA

Caudal Anesthesia in Children: Effect of Volume Versus Concentration of Bupivacaine on Blocking Spermatic Cord Traction Response During Orchidopexy

Susan T. Verghese, MD^*, Raafat S. Hannallah, MD^*, Linda Jo Rice, MD^*, A. Barry Belman, MD, and Kantilal M. Patel, PhD

Departments of *Anesthesiology, Pediatrics, and Pediatric Urology, Children’s National Medical Center and George Washington University, Washington, DC

Address correspondence to Susan Verghese, MD, Department of Anesthesiology, Children’s National Medical Center, 111 Michigan Ave., N.W., Washington, DC 20010. Address e-mail to sverghes@ cnmc.org.

In this study we compared the intensity and level of caudal blockade when two different volumes and concentrations of a fixed dose of bupivacaine were used. Fifty children, 1–6 yr old, undergoing unilateral orchidopexy received a caudal block with a fixed 2 mg/kg dose of bupivacaine immediately after the induction. Group 1 (n = 23) received 0.8 mL/kg of 0.25% bupivacaine, whereas Group 2 (n = 27) received 1.0 mL/kg of 0.2% bupivacaine. Epinephrine 1:400,000 and 0.1 mL of sodium bicarbonate per 10 mL of local anesthetic solution were added. There were no statistically significant differences between the two groups in their anesthesia, surgery, recovery, and discharge times. Fifteen patients (65.2%) in Group 1 required an increase in inspired halothane concentration to block hemodynamic and/or ventilatory response during spermatic cord traction, as compared with 8 patients (29.6%) in Group 2 (P = 0.022). In the recovery room, four (17.4%) patients in Group 1 required rescue treatment with fentanyl, versus two (7.4%) in Group 2 (P = 0.372). In children undergoing orchidopexy, a caudal block with a larger volume of dilute bupivacaine is more effective than a smaller volume of the standard 0.25% solution in blocking the peritoneal response during spermatic cord traction, with no change in the quality of postoperative analgesia.

IMPLICATIONS: In children undergoing orchidopexy, a caudal block with a larger volume of dilute bupivacaine is more effective than a smaller volume of the more concentrated solution in blocking the peritoneal response during spermatic cord traction, with no change in the quality of postoperative analgesia.

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