Objective:

We aimed to compare the analgesia quality of caudal block of low volume, high concentration bupivacaine to the conventionally used volumes and concentrations of the drug in neonates undergoing circumcision with sole caudal anesthesia.

Material and Methods:

Fifty neonates, undergoing circumcision were randomly assigned to low volume high concentration (group LVHC, n=25) and control groups (group C, n=25). In group LVHC 0.5 ml/kg bupivacaine 0.375% (1.875 mg/kg) and group C 1 ml/kg bupivacaine 0.25% (2.5 mg/kg) was used. Hemodynamic parameters, block onset and analgesia periods were compared. Pain scores were evaluated hourly for 3 hours postoperatively with NIPS (neonatal infant pain score). Student’s t-test for continuous variables, X2 and Mann– Whitney U-tests were used for nominal and/or categorical variables.

Results:

Demographic, hemodynamic data, block onset time (group LVHC and C values were 4.9±1 vs 5.2±2 mins, respectively; p=0.53) was similar and postoperative median NIPS were identical among the groups (median value of (0); p=0.7, p=0.9, p=1). None of the neonates required additional analgesic postoperatively.

Conclusions:

Low volume high concentration caudal bupivacaine provided a similar perioperative analgesia quality, time and safety profile compared to conventional doses in awake neonates undergoing circumcision. LVHC bupivacaine may be used to reduce the risk of local anesthetic toxicity in neonates.

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