Effect of supplemental caudal analgesia on intraoperative blood glucose levels in pediatric patients undergoing urological surgery under general anesthesia: An observational study

Abstract

Background: The need for intra-operative dextrose supplementation in pediatrics remains a debate. Surgical stress responses lead to hyperglycemia, while regional anesthesia obtunds the stress response and thereby, hyperglycemia. We aimed to compare the effects of supplemental caudal analgesia on intraoperative blood glucose in children undergoing urological surgery under general anesthesia (GA). Intraoperative hemodynamics and opioid consumption were also compared. Patients and Methods: This was a cross-sectional, observational study conducted in children aged 5 months-6 years undergoing urological surgery, categorized as Group R (GA with caudal analgesia) or Group G (GA only). Blood sugars were measured until 2 h following intubation. Statistical analysis was performed using the Student's t-test and Chi-square tests. Results: Age in Group R was lesser than Group G (P = 0.044), but weights were comparable. Random blood sugar (RBS) at 60 min (P = 0.008) and 90 min (P = 0.007) were significantly lower in Group R. The difference in RBS from the baseline was significantly higher in Group G at all time points. Heart rate (HR) and mean arterial pressure (MAP) were comparable except at HR 60 (P = 0.046) and MAP 60 (P = 0.014) with significantly higher values in Group G. Group R had significantly lower intraoperative fentanyl consumption with less frequent need for additional bolus. Conclusions: Supplemental caudal analgesia blunts intraoperative increases in blood glucose levels and hemodynamics with a reduced analgesic requirement, compared to GA alone in children undergoing urological surgery.