A comparative study evaluating the incidence of post operative complications with two distinct doses of morphine used as adjuvants in caudal block for paediatric patients undergoing infraumbilical surgical procedures.

Postoperative pain is a major concern in pediatric patients undergoing infraumbilical surgeries such as herniotomy, orchidopexy, and circumcision. Inadequately managed pain in children can lead to physiological stress responses, delayed recovery, and long term behavioral disturbances. Although infraumbilical surgeries are usually short in duration, effective control of postoperative pain is essential to promote early ambulation, reduce the length of hospital stay, and improve overall patient comfort.

Several analgesic strategies are used in this age group, including systemic medications such as non steroidal anti inflammatory drugs and opioids, as well as regional anesthesia techniques. Among the regional approaches, the caudal block is one of the most commonly performed procedures in pediatric anesthesia. It provides reliable intraoperative and postoperative analgesia for surgeries below the umbilicus, has a high success rate, and offers a favorable safety profile.

To prolong the duration of analgesia from caudal blocks, various adjuvants have been added to local anesthetics. Morphine, a hydrophilic opioid, is one of the most widely used adjuvants in caudal anesthesia. Doses typically range from 10 to 30 micrograms per kilogram and have been shown to extend postoperative pain relief for 12 to 24 hours. However, higher doses of caudal morphine are known to increase the risk of adverse effects including postoperative nausea and vomiting, pruritus, urinary retention, and in rare cases respiratory depression. Recent investigations comparing lower and standard doses have suggested that reducing the dose may maintain analgesic efficacy while minimizing these unwanted effects.

Considering the narrow therapeutic range of caudal morphine in young children, the present study is designed to compare the incidence of postoperative nausea, vomiting, and urinary retention between two doses, 15 micrograms per kilogram and 30 micrograms per kilogram, in children aged one to six years undergoing infraumbilical surgeries. This comparison will help determine whether a lower dose can provide effective analgesia with fewer complications.