الفهرس 
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Abstract
Caudal epidural analgesia is a commonly performed regional block for pediatric analgesia. It is a reliable and safe technique used with general anesthesia for children undergoing abdominal or lower-limb surgery. It is easily performed in younger children. However, caudal anesthesia provides a short duration of action especially when single local anesthetic dose was injected. Prolongation of caudal analgesia using a ‘single-shot’ technique has also been achieved by the addition of various adjuvants. Nalbuphine is a synthetic opioid κ-receptor agonist μ-receptor antagonist when used by intravenously, it decreases the emergence agitation in adults and pediatrics.
The aim of this study was to evaluate the efficacy of adding nalbuphine to bupivacaine via caudal block on postoperative emergence agitation in pediatrics scheduled for infra-umbilical surgeries.
This prospective randomized placebo-controlled double-blind study conducted after approval from the Institutional Ethics Committee on eighty patients between 2 to 12 years old and undergoing sub-umbilical abdominal surgeries. They were equally divided into two equal groups: group B (Control Group): 40 patients received caudal analgesia using bupivacaine 0.125 of 1 ml/kg plus 2 ml normal saline (NaCl 0.9%). group N (Nalbuphine Group): 40 patients received caudal analgesia using bupivacaine 0.125 of 1 ml/kg plus 0.2 mg/kg nalbuphine diluted in 2 ml normal saline.
Intraoperatively, the anesthetic procedure was standardized for all cases, and the same surgical team performed all surgeries. Intraoperative monitoring included the electrocardiogram, pulse oximetry (SpO2), non-invasive mean arterial blood pressure (MAP), end-tidal carbon dioxide (EtCO2), and temperature probe. All children received the caudal block then the surgical incision was started 20 minutes thereafter.
Primary outcome was the effect of caudal nalbuphine on postoperative emergence agitation according to pediatric anesthesia emergence delirium scale (PAED). Secondary outcomes included the study effects on hemodynamic parameters, postoperative pain, postoperative sedation, time to the first postoperative rescue analgesia, total amount of rescue analgesia in first 24 h postoperatively, complications, and parents’ satisfaction score.
We reported no significant differences between both groups regarding the postoperative PAED agitation scale assessment and its category at different times. Nalbuphine group had significantly more sedation immediately postoperative and 30-minute postoperative. Also, we found that nalbuphine group had significantly lower modified CHEOPS score than the control group in most study periods.
There are no statistically significant differences between both groups as regard HR, MBP, SpO2, and EtCO2 assessment at different times. It was found that nalbuphine group had significantly longer time to the 1st analgesic request with lower total analgesic dose and parent’s satisfaction scores.