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Abstract
Interest in combining regional and general anesthesia to offer the possibility of a pain-free post-operative period has increased in recent years. Caudal block is the most commonly used regional anesthesia method in lower abdominal and urological surgery in children.
Caudal epidural analgesia decreases the need for potent inhalational agents and opioids; it provides excellent postoperative analgesia without significant sedation, and allows quick and smooth emergence from general anesthesia.
Bupivacaine, a long acting amide local anesthetic, is widely used for caudal epidural analgesia in children but it is associated with a number of side effects, including motor weakness, cardiovascular and central nervous system toxicity. This has resulted in the continuing search for new and safer local anesthetic agents. The amide local anesthetic ropivacaine is a pure S-enantiomer and is structurally related to bupivacaine. Ropivacaine has been reported to have a wider safety margin with regard to both central nervous and cardiac toxicity and causes less interference with motor function when compared with bupivacaine.
The main disadvantage of caudal blockade is the relatively short duration of postoperative analgesia, even with the use of relatively long acting local anesthetic agents such as bupivacaine.
Various additives to the local anesthetic solution have been employed in an attempt to prolong the duration of a single caudal epidural injection.