دور الحصار الذيلي المستمر في التسكين عند الأطفال

الملخص EN

Background& Objective: Alleviating pain in children is one of the most exciting and rewarding of professional activities .

pediatric regional anesthesia is receiving its deserved attention as an excellent technique for a balanced intraoperative anesthesia as well as postoperative analgesia .

Continuous caudal block provides adequate duration of analgesia, not only for lower limb and lower abdominal surgeries, but also for upper abdominal and thoracic surgery , conserving the haemodynamic stability .

Materials & Methods: our prospective study was performed in the department of anaesthesia and reanimation in paediatric university hospital .through tow years 2008/2010.

the study was conducted in 40 patients of either sex aged between 3to 12 years of ASA grade 1&2 .

all the patients were premedicated 1 hour preoperation, then general anaesthesia ( with sevofloran for younger children and propofol for the elders ) and intubation with spontaneous ventilation was performed.

the caudal block was performed with G20 Toughy needle with G24 epidural catheter for the young child and G18 Toughy needle with G19 epidural catheter .mixture of xylocaine2% +bupivacaine 0,5% + adrenaline was administered .

the analgesia during & postoperation was monitored according to these following parameters : pulse, blood pressure , respiration rate .

analgesia was evaluated according to pain discomfort score .

the catheter was kept for 24 - 48 hours .

Results: we found in this study the utility of continuous caudal block in analgesia during & postoperation for long hours without remarkable haemodynamic changes when combined with General anaesthesia ,it reduces the requirement of anaesthetic agents and early extubation was performed .

we also found less incidence of advers effects compared with analgesic drugs by intravenous or oral administration .

Only in one patient of colostomy closure , it was difficult to thread the catheter , probably due to fibrotic band inside .

In three cases , general anaesthesia was supplemented right from the beginning due to nature of surgery , positional problems , not included in this study .

Conclusion: the conclusion drawn from our study are : continuous caudal block in paediatric patients is a simple & safe technique .

the threading of a catheter in caudal space is easier.

in combination with general anaesthesia, continuous caudal block provides best balanced anaesthesia , it provides satisfactory postoperative analgesia