Extended caudal analgesia using caudally administered nalbuphine as an adjuvant for levobupivacaine in toddlers undergoing hypospadias repair: A randomized controlled clinical trial

Document Type : Original Article

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Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Abstract

Background: Caudal anesthesia is the most reliable neuraxial anesthetic practice in pediatric population and is increasingly performed in pediatric regional anesthesia practices. Aim: This prospective randomized double blind study was done to compare the effects of caudally administered plain levobupivacaine versus Levobupivacaine plus nalbuphine as single-shot for postoperative pain relief in toddlers undergoing hypospadias correction surgery. Methods: A total of 64 pediatrics were prospectively randomized into two groups: Group L: Patients received caudal levobupivacaine only. Group LN: Patients received caudal levobupivacaine plus nalbuphine. Postoperative analgesia indicated by Face, Leg, Activity, Cry, Consolability (FLACC) pain scale, time to first analgesic request, total consumption of rescue analgesic and occurrence of complications were all recorded. Results: There was statistically significant higher FLACC score in group L than group LN at 30 min and up to 8 hours. The difference between the two groups regarding time to first analgesic request was significantly longer in group LN with significantly lower analgesic consumption. No patients in both groups had respiratory depression, xerostomia or pruritis. Few patients had postoperative nausea and vomiting with no statistically significant difference between the two groups. Conclusion: The combination between nalbuphine and Levobupivacaine was valuable as regarding efficacy and safety profiles in caudal analgesia in toddlers. The intensity and duration of analgesia were remarkable compared to levobupivacaine alone with negligible side effects.

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Ain Shams Medical Journal
Volume 74, Issue 1
March 2023
Pages 173-182

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