The plasma concentrations of lidocaine were measured by HPLC(high-performance liquid-chromatography) when 415 mg of 1.5 and 2% plain lidocaine(group 1), carbonated lidocaine(group 2) and lidocaine with epinephrine(group 3) were injected into the caudal spaces of 30 patients. Peak concentrations were achieved 15, 20 and 30 min, after injection in group 1,2 and 3, respectively. The maximum values of mean concentration in group 1,2 and 3 were 3.30+/-0.83, 3.31+/-0.81 and 1.86+/-0.52 ug/ml (mean+/-SD), respectively. The plasma concentration in group 3 were lower than those in groups 1 and 2 at intervals of 5,10,15 and 20 min. However, it was uncertain whether carbonated lidocaine was absorbed more rapidly thus producing significantly higher blood concentrations. The results indicated a significant difference in the plasma concentration of epinephrine-mixed lidocaine from that of plain or carbonated lidocaine. We suggest that in caudal anesthesia, epinephrine(1:200,000) with lidocaine has an advantage with respect to lowering the plasma concentration of lidocaine.
Anesthesia, Caudal* ; Carbon ; Humans ; Lidocaine* ; Plasma*

BACKGROUND: Caudal epidural anesthesia is commonly performed in conjunction with general anesthesia. Bupivacaine and Levobupivacaine are used in epidural blockade that provide anesthesia and analgesia intraoperative and post-operatively.

OBJECTIVES: To compare the intraoperative and postoperative efficacy and safety of Bupivacaine and Levobupivacaine in children undergoing elective sub-umbilical operations under general and caudal anesthesia.

METHODS: Randomized control trial done in Philippine Children's Medical Center. Sixty-one subjects aged 6-months -8 years old, ASA I-II, undergoing subumbilical operations were randomly grouped to receive Bupivacaine and Levobupivacaine during anesthesia induction. Hemodynamic parameters, Bromage, and CHIPPS were recorded.

RESULTS: Results suggest both drugs have a significant effect in lowering heart rate and MAP. Bromage scores for patients from both groups are consistent at 0. The number of patients with a CHIPPS classification of 4-10, is significantly higher for bupivacaine group than levobupivacaine group.

CONCLUSION: Both Bupivacaine and Levobupivacaine provide adequate analgesia intraoperatively with no reports of intraoperative movement, increased inhalational agent concentration and additional intravenous analgesics. Post-operatively, no adverse effects and motor block was noted however Levobupivacaine has a longer efficacy as it required lesser rescue does post-operatively compared to Bupivacaine. 

No abstract available.
Anesthesia, Caudal* ; Hernia, Inguinal* ; Humans ; Infant* ; Masks* ; Ventilation*

Spinal anesthesia in preterm infants offers a safe alternative to general anesthesia, especially if general anesthesia is not preferred because of coexisting diseases, such as bronchopulmonary dysplasia and recurring of apnea. But the single-shot technique of spinal anesthesia has some limitations because the duration of surgical anesthesia is approximately 60 min. Since some procedures may require more time, alternative regional techniques which provide more prolonged surgical anesthesia are needed. We present our experience with a combined spinal caudal anesthesia in a preterm infant.
Anesthesia ; Anesthesia, Caudal* ; Anesthesia, General ; Anesthesia, Spinal* ; Apnea ; Bronchopulmonary Dysplasia ; Humans ; Infant, Newborn ; Infant, Premature*

Caudal anesthesia appears to be a safe and reliable technique for surgical anesthesia as well as an alternative to narcotics for postoperative analgesia for procedure below umbilicus. From January 1990 to December 1992, we examined the trend and distribution of the 1038 cases of caudal anesthesia retrospectively according to year, age, surgieal department, type of operation, operation time, local anesthetics and suecess rate. Annual numbers of caudal anesthesia increased with years and the first decade of life was the greatest number. The most common department and operation time were general surgery and 30~60 minutes. 2% or 1% lidocaine with epinephrine was the major local anesthetics used during caudal anesthesia and overall success rate was 95.5%.
Analgesia ; Anesthesia ; Anesthesia, Caudal* ; Anesthesia, Conduction ; Anesthetics, Local ; Epinephrine ; Lidocaine ; Narcotics ; Retrospective Studies ; Umbilicus

Pediatric caudal anesthesia appears to be a safe and reliable technique for surgical procedures below the umbilicus. Advantages of caudal anesthesia in infants and children include the simplicity of the technique, the high success rate, the post operative pain relief and the rare complication rate. The aim of this study was to determine an ideal local anesthetic agent and its dosage for clinical practice in pediatric caudal anesthesia. Caudal anesthesia was given to 97 patients who were divided into three groups. Group I was given 1% lidocaine l ml/kg, Group 2 was given 1% lidocaine 0.7 ml/kg and Group 3 was given 0.25% bupivacaine 1 ml/kg. All caudal blocks were carried out in the left lateral position after thiopental 4-5 mg/kg iv or under general anesthesia with halothane. The duration of anesthesia, the side effects during and after operation, the post operative pain score, motor activity, and sensory level were observed and compared among the three groups. As the result of this study, we think that caudal anesthesia using 1% lidocaine and 0.25% bupivacaine is a safe, simple and practical method in clinical practice for infants and children. The duration of anesthesia ranged from 60 to 120 minutes, and side effects were rare and insignificant. The patients position for caudal blocks was most suitable in the left lateral position. We came to the conclusion that the use of 1% lidocaine 1 ml/kg is most practical in safe practice of pediatric caudal anesthesia and 1% lidocaine 0.7 ml/kg and 0.25% bupivacaine l ml/ kg can be recommended depending on the surgical locations and required time for surgical procedures.
Anesthesia ; Anesthesia, Caudal* ; Anesthesia, General ; Bupivacaine* ; Child ; Halothane ; Humans ; Infant ; Lidocaine ; Motor Activity ; Thiopental ; Umbilicus

BACKGROUND: Caudal block is a popular regional anesthesia in children undergoing infraumbilical surgeries including inguinal hernia repair and orchiopexy. We evaluated the efficacy of eutectic mixture of local anesthetic (EMLA) cream for reducing needle insertion pain during caudal block in pediatric patients. METHODS: Forty-one children between the ages of 13 months and 5 years undergoing infraumbilical surgery were randomized to receive either topical EMLA or placebo cream over the sacral hiatus one hour before caudal block. All children were assessed with the Multidimensional Assessment Pain Scale (MAPS) at the following time points. T0: arrival at the operation room; T1: just before needle insertion; T2: immediately after needle insertion into the sacral hiatus. The need for sevoflurane inhalation due to procedural pain response was also assessed at the same time as MAPS assessment. RESULTS: MAPS scores were significantly lower in the EMLA group compared with the placebo group at T2 (P = 0.001). Moreover, need for sevoflurane inhalation due to procedural pain response was significantly lower in the EMLA group compared with the control group at T2 (P < 0.001). CONCLUSIONS: We suggest that pretreatment with EMLA cream over the sacral hiatus before caudal block has significant advantages in alleviating procedure pain during caudal block in children.
Anesthesia, Caudal ; Anesthesia, Conduction ; Child* ; Hernia, Inguinal ; Humans ; Inhalation ; Needles ; Orchiopexy ; Pediatrics ; Punctures* ; Skin*

Thirty-six adult patients who received caudal anesthesia for perianal surgery were rando-mly agsigned to two grgups. Of these, 15 patients ingroup 1 were given 1.5 and 2% plain lidocaine in 18 and 7 ml doses, repectively. Twenty-one patients in group 2 were given lidooaine carbonated with 5% NaHCO3 0.1 ml per 1 ml-lidocaine in the same volume and concentration as in group 1. The time of onset of analgesia for the pin prick and scratch tests was significantly more rapid in group 2(2.04+/-0.63 and 4,69+/-1.12 min for the pin prick and scratch tests, respecti-vely-) than those in group 1(5.00+/-1.70 and 9.48+/-5.40 min for the pin prick and scratch test, respectively). However, the duration of anesthesia in both groups was not significantly different (111.80 +/-40.24 and 105.95+/-45.04 min in group 1 and 2, respectively). The mean pH of the 1.5 and 2% agents used in group 1 was 5.289+/-0.206 and 5.257+/-0.193, respectively, while the mean PH of the 1.5 and 2% carbonated lidocaine used in group 2 was 7.004+/-0.079 and 7.023+/-0.288, reapectively. The results iridicate that pH-adjusted lidocaine for caudal anesthesia has a more rapid onset than plain lidocaine hut that there is no difference in the length of duration of its effect.
Adult ; Analgesia ; Anesthesia ; Anesthesia, Caudal ; Bone Marrow* ; Carbon ; Humans ; Hydrogen-Ion Concentration ; Lidocaine ; Tissue Donors*

Increasing the pH of local anesthetic solution with sodium bicarbonate has been known to hasten its onset of action. This study was designed to verify the effect of pH adjustment of bupivacaine on caudal anesthesia. Forty adult male patients having caudal block for perianal surgery were randomly assigned to four groups(n=l0) as follows. Group 1: control, 0.5% bupivacaine 20ml+0.6ml saline Group 2: 0.5% bupivacaine 20 ml+0.1% epinephrine 0.1 ml+0.5ml saline Group 3: 0.5 bupivacaine 20ml+5% sodium bicarbonate 0.5ml+0.1 ml saline Group 4: 0.5% bupivacaine 20 ml+5% sodium bicarbonate 0.5ml+0.1% epinephrine 0.1 ml The pH of prepared solution of each group is 6.23+/-0.032, 5.95+/-0.028, 7.35+/-0.054, 6.92+/-0.067 respectively. The time of onset of anesthesia (time between the completion of anesthetic injection and loss of temperature sensation at S4, S5 dermatome) was significantly rapid in group 3 followed by group 4. The time of onset of surgical anesthesia (time between the completion of anesthetic injection and loss of pain sensation by pin-prick test at S4, S5 dermatome) was significantly rapid in group 3.
Adult ; Anesthesia ; Anesthesia, Caudal* ; Bupivacaine* ; Epinephrine ; Humans ; Hydrogen-Ion Concentration* ; Male ; Sensation ; Sodium Bicarbonate

The caudal block has been used as an alternative to general anesthesia in specific circumstances such as anal surgery, perineal surgery or surgery of lower extremity etc. It has been also used as an adjunct to general anesthesia, administered at the completion of surgery to provide postoperative analgesia especially in children. But, it has variable complications such as generalized intoxication, pain on the injection site, infection or urinary retention etc. We report an unusual case of metastatic sacrococcygeal tumor from adenocarcinoma of lung presenting as severe anal pain and sciatica which was aggravated after the trial of caudal anesthesia.
Adenocarcinoma* ; Analgesia ; Anesthesia, Caudal* ; Anesthesia, General ; Child ; Humans ; Lower Extremity ; Lung* ; Sciatica ; Urinary Retention