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Materials and Methods: After IRB approval and informed parental consent, 30 children (ASA I, 1-5 years old) were included. After premedication with midazolam, anesthesia was induced with thiopental and maintained with sevoflurane in oxygen/air. After induction, patients received a caudal blockade either with ropivacaine 0.375% at 0.5 ml/kg (Low Volume High Concentration Group, LVHC; n = 15), or ropivacaine 0.1 % at 1.8 ml/kg (High Volume Low Concentration Group, HVLC; n = 15). Surgery was allowed to begin ten minutes after performing the block. In the recovery room, pain was assessed using the CHEOPS Pain Scale and the motor block was scored with a modified Bromage scale. After transferral to the ward, the patients were observed for 24 hours for signs of postoperative pain. The time period to first supplemental analgesic demand, i.e., from establishment of the block until the first registration of a CHEOPS score ≥ 9, was considered the primary endpoint of the study. The time periods were compared using analysis of variance adjusted for age, weight and duration of surgical procedure as covariates.
Results and Discussions: All patients were judged to have sufficient intraoperative analgesia. Patients' characteristics were similar, besides the age (32 ± 10 (LVHC) vs. 24 ± 9 months (HVLC); p < 0.05). Analgesics were needed after 520 ± 480 min in the LVHC and 952 ± 506 min in the HVLC group (p < 0.05). Motor block was less in the HVLC group.
Conclusion(s): In children undergoing hypospadia repair, caudal block with a “high volume, low concentration” regimen produces prolonged analgesia and less motor block, compared to a “low volume, high conc.” regimen.
