Comparative Analysis of the Postoperative Analgesic Effect of Caudal Ropivacaine Versus Ropivacaine With Nalbuphine in Infra-Umbilical Pediatric Surgeries: A Randomized, Double-Blind Pilot Study

Postoperative pain in children leads to an immense stress response than adults, leading to an increased hospital stay and "pain memory." Caudal epidural anesthesia is one of the most reliable, popular, and safe techniques that provide proper analgesia for infra-umbilical surgeries. A combination of local anesthetics and opioids reduces the dose-related adverse effects of each drug independently. In this study, we evaluated the drug nalbuphine as an additive to ropivacaine and plain ropivacaine in a caudal epidural to test the duration of postoperative analgesia and the need for IV paracetamol. The study conducted was a prospective, randomized, double-blind, and pilot study with size of 60 children aged two to 12 years of American Society of Anesthesiologists (ASA) 1 and 2 posted for infra umbilical surgeries, divided into two groups of Group R (0.75 mL/kg of 0.25% ropivacaine) and Group RN (0.75 mL/kg of 0.25% ropivacaine with 0.1 mg/kg nalbuphine) with 30 each. A caudal epidural was administered 20 minutes before the incision after induction of anesthesia. The child was monitored perioperatively for 24 hours for vitals, Face, Legs, Activity, Cry, and Consolability (FLACC) score, adverse effects, and the need for rescue analgesia, which were recorded and analyzed. The addition of nalbuphine to caudal ropivacaine prolonged the analgesia from six hours to 12-18 hours postoperatively. It also decreased the doses of intravenous (IV) paracetamol and completely nil use in 50% of the population. To conclude, nalbuphine as an additive in caudal epidural compared to plain ropivacaine alone provided better analgesia. It prolonged the duration of analgesia with decreased use of postoperative IV paracetamol.