Effect of nalbuphine as an adjuvant on levobupivacaine induced caudal analgesia in children undergoing surgical procedures, controlled randomized double blinded study

Background
To reduce intraoperative use of volatile anesthetics, a successful caudal blockade affords the anesthesiologist this opportunity. The use of a narcotic-sparing approach may benefit the patient, with providing a better postoperative course with less nausea.
Aim of the work
To compare the effects of plain levobupivacaine 0.25% 1 ml/kg and levobupivacaine 0.25% 1 ml/kg plus nalbuphine 0.1 mg/kg single-shot caudal epidural for perioperative pain relief in children undergoing surgeries of lower half of the body.
Patients and methods
The study was conducted in Abou El-Reesh pediatric hospital, Cairo University, after approval of ethical committee and obtaining consent from parents on 40 patient aged 1–9 years scheduled for surgeries of lower half of the body. (Group L,  = 20): Caudal block was done in this group using levobupivacaine 0.25% with the dose of 1 ml/kg after induction of general anesthesia. (Group L + N,  = 20): Caudal block was done in this group using levobupivacaine 0.25% with the dose of 1 ml/kg and nalbuphine 0.1 mg/kg after induction of general anesthesia.
Results
The time to first analgesia was significantly longer in Group L + N (0.01) than that in the other group. The mean time for first rescue analgesia was 5.9 ± 1.0 h in Group L compared to that in Group L + N, which was 11.2 ± 1.6 h. Comparing the pain scores (AIIMS pain score) of the two groups at 2, 4, 6, 12 and 24 h postoperatively revealed that there was significant difference between Group L + N and Group L at 4, 6 and 12 h with higher pain scores in the (Group L) than in the other Group (L + N). This shows that the duration of analgesia in the (L + N) group was longer than the other group. The results show there was difference in the sedation score between the two groups in the 1st hour postoperative. The L + N group had higher sedation scores at 30 min and at 1 h postoperative.
Conclusion
Caudal epidural nalbuphine is safe in pediatric surgeries including the lower half of the body and effectively reduces postoperative pain. However it may cause early postoperative sedation, yet without respiratory depression.