Effect of Multimodal Analgesia Versus Caudal Analgesia on Intraoperative Surgical Stress Responses and Analgesia in Pediatric Cancer Patients

Background: Stress response to surgery and perioperative pain induces changes in hormonal secretion. Tissue trauma that occurs following surgical interventions is associated with both metabolic and endocrine responses. The present study was performed during upper abdominal surgery (suprarenal neuroblastoma), to compare the efficacy of multimodal analgesia versus caudal block on intraoperative analgesia and attenuation of endocrine response during surgery. Methods: Forty children aged 2-7 years were randomly allocated into two groups: Multimodal group (group M, n=20) received ketorolac infusion 1mg/kg, paracetamol infusion 10mg/kg, ketamine 0.5mg/kg IV and local anesthetic wound infiltration (LAI) with (lidocaine 0.3-0.5% and bupivacaine 0.125%) after induction of anesthesia and before surgical incision and caudal group (group C, n=20) received caudal block with 0.25% bupivacaine 1 ml/kg and morphine 0.02mg/ kg after induction of anesthesia and before surgical incision. Blood samples were withdrawn after induction of anesthesia (T1) and 120 min after surgical incision (T2). Results: Significantly higher number of patients (70%) in group C versus (30%) in group M needed intraoperative rescue fentanyl (p=0.011). In both groups (T1) values for cortisol and growth hormone were within the normal ranges and there were no differences between groups (p 0.05). In both groups, T2 values increased, compared with T1 values (p 0.001). However both the serum cortisol and growth hormone levels were within the normal range at all times. Conclusion: Intravenous multimodal analgesia supplemented with (LAI) has superior intraoperative analgesic profile to caudal analgesia and both techniques can attenuate the intraoperative endocrine response to surgery.