Role of Caudal Epidural Block in enhanced recovery after pediatric oncologic surgery. Article

Abstract

Introduction. Enhanced recovery after surgery and the early initiation of chemotherapy is a significant advantage of laparoscopic surgeries for malignant tumors of abdominal cavity in children. Despite the extensive experience in using caudal block in pediatric patients, it has not yet been determined whether the use of ultrasound navigation provides any clinical advantage in post-operative recovery after laparoscopic surgeries in pediatric oncology. Materials and methods. The study included 40 patients of Pediatric Oncology and Hematology, Federal Blokhin National Medical Research Center, ASA II-III, who underwent laparoscopic surgeries for malignant tumors of the abdominal cavity during 2017-2019. Patients were divided randomly into 2 groups. The CB (caudal blockade) group included 23 children. In CB group caudal epidural block as a regional component of combined anesthesia was used (CB group n = 23). GA (general anesthesia) group included 17 children who underwent general anesthesia (GA group, n = 17). Results. The median of the total dose of fentanyl in the CB group was 7.29 (6; 9.25) |ig/kg, in the GA group - 10.7 (7.6; 12.5) |ig/kg (р < 0.012). In the postoperative period, patients in CB group didn’t require additional analgesia for 24 hours after caudal-epidural administration of morphine. After caudal-epidural administration of trimeperidin, 12 hours later. Enteral nutrition in children in the CB group was started in 4.7 ± 0.5 hours. In the GA group, enteral nutrition in 10 (59 %) patients was started in 20 hours after the end of the surgery. 5 children developed gastrostasis, which required pharmacologic stimulation of the gastrointestinal tract. Conclusions. This study demonstrates that caudal epidural block for laparoscopic surgeries performed under ultrasound navigation provides effective analgesia in both perioperative and postoperative periods, promotes early start of enteral nutrition, minimizing the frequency of postoperative nausea and vomiting. Ultrasound navigation increases the likelihood of success and safety of the caudal epidural block.