Comparative Study between Multimodal Analgesia Versus Caudal Analgesia for Postoperative Analgesia in Pediatric Cancer Patients Undergoing Abdominal Surgeries

Background: Caudal analgesia is commonly used for perioperative pain control in pediatric abdominal surgeries. The aim of this study was to compare preemptive intravenous multimodal analgesia supplemented with local anesthetic infiltration (LAI) versus preemptive caudal analgesia with bupivacaine and morphine, regarding postoperative pain and adverse effects in pediatric patients undergoing abdominal surgery for excision of suprarenal neuroblastoma.Methods: Forty patients were randomly enrolled in the study; patients were divided into 2 groups; multimodal group (group M, n=20) received ketorolac, paracetamol, ketamine supplemented with LAI before surgical incision and caudal group (group C, n=20) received caudal block done before surgical incision.Results: The mean time to the first rescue analgesic requirement was significantly longer in group M (7.3±2.8) hours than in group C (4.6±2.7) hours (p 0.005). The mean morphine consumption in the first 24 hours postoperatively was higher in group C (3.3±1.2) mg than in group M (2.1±0.6) mg (p 0.01). The median pain score was lower in group M in PACU but both groups were comparable at 2 to 24 hours.Conclusion: Intravenous multimodal analgesia supplemented with LAI improves analgesia in PACU and reduces morphine consumption within the first 24h postoperatively more than single dose caudal analgesia in pediatric abdominal surgeries.