Effect of supplemental caudal analgesia on intraoperative blood glucose level in pediatric patients undergoing infraumbilical surgery

Surgery induces a neuroendocrine stress response resulting in changes of metabolic state and immune function. The stress response stimulates release of catecholamines and cortisol which have an anti-insulin action predisposing to increase plasma glucose levels. Hyperglycaemia increases the risk of hypoxic-ischemic brain or spinal cord damage, induces diuresis and subsequently dehydration and electrolyte imbalance.

Pain is a major cause of stress in children and should be managed optimally in the perioperative period to reduce the adverse effects of stress response. Systemic analgesics and/or local anaesthetics in regional anaesthesia are administered for perioperative pain management which also blunts the surgical stress response. Caudal block is the most commonly employed technique of regional anaesthesia in children undergoing infraumbilical surgery for pain relief which may attenuate stress response and optimise blood glucose levels by inhibition of endogenous glucose production.

Currently there is paucity of studies that have observed the effect of caudal analgesia on blood glucose level in children. Hence in our study we aim to compare the blood glucose level in children under general anaesthesia with and without caudal analgesia.

We hypothesize that supplemental caudal analgesia with general anaesthesia may influence the intraoperative blood glucose levels.