Abstract

PR2-175

COMPARISON OF CAUDAL EPIDURAL BLOCK WITH PARAVERTEBRAL BLOCK FOR RENAL SURGERIES IN PAEDIATRIC PATIENTS

Kashyap L, Narasimhan P, Mohan V, Shende D, Arora M
All India Institute of Medical Sciences, New Delhi, New delhi, India

INTRODUCTION
Renal surgeries are associated with significant post-operative pain. Multimodal analgesic techniques, namely systemic and regional, have been used. Pediatric regional blocks are usually performed under general anesthesia. Ultrasound-guidance to perform the blocks ensures safety and success. This study was undertaken to compare the analgesic efficacy of ultrasound-guided single shot caudal block with ultrasound-guided single shot paravertebral block in children undergoing renal surgeries. Time to first analgesic requirement, 24-hour FLACC scores and analgesic consumption, parental satisfaction and the hemodynamics were studied.
METHODS
After ethical committee approval and informed written parental consent, 50 children aged 2-10 years, of ASA status I/II, posted for elective renal surgeries were randomised into two groups(Group C-caudal block, Group P-paravertebral block), for a prospective single blind interventional study. Statistical analysis was done using STRATA 14.0 and SPSS 20.0. Chi square/Fisher exact test, paired samples ttest, Mann-Whitney U test were used for comparisons between the two groups. Kaplan-Meier survival estimate was used for analysis of primary outcomes. p<0.05 was considered significant.
RESULTS
Demographics were comparable between both the groups. Children in Group P had significantly longer duration of analgesia (p< 0.0004) than Group C ( Graph 1). Post-operative FLACC scores (p<0.005), analgesic requirements (p<0.0004) were lower in Group P. Parents in Group P reported greater satisfaction (p< 0.02).No complications were seen in either of the groups.
DISCUSSION
Caudal epidural has used for perioperative analgesia in children but is associated with higher incidence of side effects. Paravertebral block as single shot or continuous infusion has been used to provide good perioperative analgesia. Single-shot paravertebral block provide clinically relevant post-operative analgesia. 1 Berta and coworkers studied 24 children who underwent major renal surgery and concluded that postoperative analgesia can be achieved by single shot PVB injection in children undergoing major renal surgery. Similarly we found analgesia for an extended period in most children in PVB group. 15 of 25 children administered PVB did not require any analgesia during the first 24 hours postoperatively. We found that PVB provided better analgesia than caudal block.
CONCLUSION
Paravertebral block can be an alternative analgesic modality for renal surgeries in children.

Graph 1: KM curve comparing the rescue analgesic requirement

REFERENCES

1. Berta E et al. Single injection paravertebral block for renal surgery in children. Pediatric Anesthesia 2008;18:593-597
2. Ozcengiz D et al. Single level paravertebral versus caudal block in paediatric inguinal surgery. Anaesth Intensive Care 2011 Sep;39:909-913