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Does adding intravenous fentanyl to caudal block in children enhance the efficacy of multimodal analgesia as reflected in the plasma level of catecholamines?

Published online by Cambridge University Press:  01 May 2007

M. Somri ,
R. Tome ,
C. B. Teszler ,
S. J. Vaida ,
J. Mogilner ,
A. Shneeifi ,
L. Nurit ,
G. Avital ,
O. Zinder  and
L. A. Gaitini
M. Somri*
Affiliation:
Technion – Israel Institute of Technology, Bruce Rappaport Faculty of Medicine, Anaesthesiology Department, Haifa, Israel
R. Tome
Affiliation:
Technion – Israel Institute of Technology, Bruce Rappaport Faculty of Medicine, Anaesthesiology Department, Haifa, Israel
C. B. Teszler
Affiliation:
Technion – Israel Institute of Technology, Bruce Rappaport Faculty of Medicine, Anaesthesiology Department, Haifa, Israel
S. J. Vaida
Affiliation:
Technion – Israel Institute of Technology, Bruce Rappaport Faculty of Medicine, Anaesthesiology Department, Haifa, Israel
J. Mogilner
Affiliation:
Department of Paediatric Surgery, Bnai Zion Medical Center, Haifa, Israel
A. Shneeifi
Affiliation:
Technion – Israel Institute of Technology, Bruce Rappaport Faculty of Medicine, Anaesthesiology Department, Haifa, Israel
L. Nurit
Affiliation:
Department of Clinical Biochemistry, Rambam Medical Center, Haifa, Israel
G. Avital
Affiliation:
Department of Clinical Biochemistry, Rambam Medical Center, Haifa, Israel
O. Zinder
Affiliation:
Department of Clinical Biochemistry, Rambam Medical Center, Haifa, Israel
L. A. Gaitini
Affiliation:
Technion – Israel Institute of Technology, Bruce Rappaport Faculty of Medicine, Anaesthesiology Department, Haifa, Israel
*
Correspondence to: Mostafa Somri, Department of Anaesthesia, Bnai-Zion Medical Center, POB 4940, 31048 Haifa, Israel. E-mail: somri_m@yahoo.com; Tel: +972 4 8359346; Fax: +972 4 8359821
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Summary

Background and objective

Several studies showed that single analgesic modality management can attenuate perioperative stress, but little is known about the effect of multimodal analgesia on catecholamine responses to surgical trauma in children.

Methods

Fifty children (American Society of Anesthesiologists Grade I or II) were randomly allocated to one of two groups: one received general anaesthesia and a caudal block (control group), and one group was given general anaesthesia, caudal block and intravenous (i.v.) fentanyl 2 μg kg−1 (fentanyl group). Plasma epinephrine and norepinephrine concentrations were measured three times during the perioperative period: at induction time (T0), at the end of surgery (T1) and when the children were fully awake in the postanaesthesia care unit (T2).

Results

There was a significant reduction in the catecholamine levels in the two groups when (T1) and (T2) were compared with T0. When plasma epinephrine levels (at T0, T1 and T2) between the two groups were compared, a statistically significant reduction at T2 was obtained in the fentanyl group, when compared with the control group. However, plasma norepinephrine levels showed no statistically significant difference between the two groups (at T0, T1 and T2).

Conclusion

These findings suggest that the multimodal analgesic approach of adding i.v. low-dose fentanyl to a caudal block may decrease the plasma epinephrine release in children undergoing inguinal herniotomy.

Keywords

ANAESTHESIA GENERAL, paediatricSTRESS RESPONSECOMBINED MODALITY THERAPYCATECHOLAMINES, epinephrine, norepinephrineCHILDANAESTHESIA CAUDALFENTANYL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 5 , May 2007 , pp. 408 - 413
Copyright
Copyright © European Society of Anaesthesiology 2006

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