Comparative Study Of The Effectiveness Of Morphine Combined With Bupivacaine Versus Bupivacaine Alone For Caudal Blocks In Paediatric Patients Undergoing Infraumbilical Surgeries At Kenyatta National Hospital

Abstract

Background: Uncontrolled pain is often associated with increased incidence of postoperative nausea and delirium, prolonged Post Anaesthesia Care Unit (PACU) stay, delayed hospital discharge and delayed resumption of normal activities.(1) Caudal block is one of the most popular anaesthetic regional blocks performed in children worldwide. It provides efficient analgesia both intra- and postoperatively. Bupivacaine is commonly used for caudal block but its effects usually wear off early. Various additives such as morphine have been used to prolong the postoperative analgesic effects of caudal bupivacaine. Objective: To compare perioperative analgesic effectiveness of bupivacaine combined with morphine and bupivacaine alone for caudal block. Methodology: This was a comparative observational study that was carried out in paediatric ward, paediatric theatre and PACU. 122 patients aged between 2 months and 12 years were included. Of these, 61 patients received bupivacaine alone and 61 patients received bupivacaine-morphine for caudal block. Patients were monitored for 24 hours and duration of analgesia was noted. Results: 90% of the patients in the bupivacaine-morphine group had analgesia for more than 24 hours and did not receive rescue analgesia. 95% of patients in the bupivacaine group required rescue analgesia within the first 8 hours of surgery. 0.1 % (n=6) developed pruritus and these were patients in the bupivacaine-morphine group. No other adverse effects were reported. Conclusion: Caudal block using low dose morphine combined with bupivacaine had a prolonged analgesic effect compared to bupivacaine alone in paediatric patients undergoing infra-umbilical surgery at the KNH.