الفهرس 
C AUDAL C ANAL B LOCKOnly 14 pages are availabe for public view
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Abstract
Background: There is some evidence that early analgesic may reduce the incidence of chronic pain after surgery via suppression of central neural sensitization before the nociceptive stimulus triggered the activation of pain pathway. Caudal block is increasingly performed in pediatric regional anesthesia practices. It is preferred in order to relieve postoperative pain in children of all age groups undergoing pelvi-abdominal or lower limbs surgeries. Day-case surgical procedures in pediatrics have increased. Therefore, postoperative pain should be effectively relieved in a safe manner. These patients have a shorter hospital stay, and side effects may not be noticed at home. Caudal block has the importance in decreasing consumption of systemic analgesics.
Objective: To compare the effects of plain levobupivacaine 0.25% and levobupivacaine 0.25% plus nalbuphine 0.1 mg/kg single-shot caudal epidural for postoperative pain relief in children undergoing hypospadius repair surgeries.
Patients and Methods: This prospective double blind, randomized study is designed to explore and compare the effect of adding nalbuphine to levobupivacaine versus levobupivacaine alone for treating post-operative pain in children undergoing hypospadias repair surgeries. Our ultimate goal is to identify the time during which the child remain pain free post-operative before the first rescue analgesia is given and the total consumption of rescue analgesia.
Results: We found that the use of nalbuphine, during single dose injection, as an additive to the local anethetic levobupivacaine in caudal epidural analgesia prolongs the duration of postoperative analgesia following hypospadias repair surgery compared with levobupivacaine alone. The addition of low dose nalbuphine 0.1 mg/kg body weight to 0.25% levobupivacaine (1ml/kg body weight) significantly improved the quality as well as the duration of analgesia after hypospadias repair surgery in children aged 1_3 year. Duration of analgesia was prolonged significantly where nalbuphine was administered along with levobupivacaine without significant increase in occurrence of complications. There was no incidence of respiratory depression or pruritis in the caudal nalbuphine group patients.
Conclusion: The combination between nalbuphine and Levobupivacaine was valuable as regarding efficacy and safety profiles in pediatric analgesia. The intensity and duration of analgesia were remarkable compared to levobupivacaine alone. Fortunately, there were no side effects of systemic hazards recorded from systemic absorption of nalbuphine. To recommend considering nalbuphine as one of the valuable adjuvants to levobupivacaine in epidural analgesia according to its efficacy and safety profile.