Comparison between caudal levobupivacaine versus levobupivacaine–nalbuphine for postoperative analgesia in children undergoing hernia repair: A randomized controlled double blind study

Objectives
Caudal analgesia is widely used in children; the aim of this trial was to evaluate the efficacy of adding nalbuphine to local anesthetic in pediatric patients undergoing hernia repair.
Patients and methods
This randomized double-blind controlled trial was done in department of anesthesia, Cairo University hospitals, and 40 patients with ASA physical status classification I–II, aged 2–7 years were enrolled in this study and randomly assigned into 2 groups; group L received caudal levobupivacaine 1 ml/kg with concentration of 0.25% and group LN received caudal 0.125% levobupivacaine with volume of 1 ml/kg plus 0.2 mg/kg nalbuphine. Pain was evaluated immediately after emergence (FLACC 0 h), after 1 h in the PACU, after 2, 3, 4, 5, 6 and 12 h by the FLACC pain score (Face, Leg, Activity, Crying, Consolability). First time of rescue analgesic, total dose of rescue analgesic and side effects were observed for 12 h.
Results
FLACC pain scores were much less in LN group compared to L group ( value < 0.001) after the second hour. The first time for postoperative analgesic requirement was significantly longer in LN group (384 ± 23.1 min) compared to L group (202.20 ± 23.42 min) ( value > 0.001). The total dose of postoperative supplementary analgesia (intravenous paracetamol infusion) in the first 12 h was significantly lower in LN group (200.5 ± 65.5 mg) in comparison with L group (355.25 ± 69.9 mg) ( < 0.05).
Conclusions
Combining caudal anesthesia using levobupivacaine and nalbuphine provided prolonged time of analgesia with no reported side effects.