The evaluation of the caudal block performance in 0–8-year-old children using FLACC scale

Abstract

Purpose: The evaluation of postoperative pain in pediatrics is a true challenge. We aimed to evaluate the immediate postoperative pain management using FLACC (Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Pain Scale) scale after caudal block. Material and Methods: The anesthesia records of children aged 0–8 years who underwent caudal block under general anesthesia prior to surgery were evaluated. The intraoperative and postoperative use of opioids were obtained, as well as, the FLACC scores. Results: Seventy-eight children were included and evaluated in two groups according to ages of 1-24 (n=37) and 24-96 months (n=41). Intraoperative requirement for opioid was observed in 7.7% (n=6) of patients. Nine patients (11.5%) required fentanyl in the immediate postoperative period with FLACC ≥4. Only 1 patient required opioids both intraoperatively and in the immediate postoperative period, suggesting a success rate of 98.7%. The patients were observed to receive single dose opioid, despite FLACC ≥4 in the following postoperative 1st,2nd and 3rd hours. The subgroups of age were similar in terms of FLACC scores and the changes in these scores within the postoperative 3 hours. There were no urinary retention or motor block. However, paresthesia was recorded in 4 patients at age of 24-96 months, whereas, in none of the patients at age of 1-24 months. The uncomfortable numbness, which could not be described at age of 1-24 months may have caused the difference, as well as, leading to high FLACC scores without any opioid use. Conclusion: Our study supported that anesthetists consider FLACC scale as a part of pain assessment to administer opioid, not as a sole indicator.