Combination Effects of General Anesthesia with Continuous Caudal Block Using Ropivacaine Compared to General Anesthesia on Inflammation and Length of Stay in Pediatric Patients After Urethroplasty: A Randomized Controlled Trial

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Abstract Background: Surgery triggered a significant sympathetic stress response that mediates inflammation and pain. Urethroplasty is often performed repeatedly in pediatric patients, which leads to significant psychological stress and severe pain due to this inflammatory response. This study aimed to determine whether a combined technique of general anesthesia (GA) with a continuous caudal block improved outcomes compared with GA alone. Materials and Methods: A randomized controlled trial was conducted involving 34 pediatric patients aged 1–10 years undergoing urethroplasty. Participants were randomly assigned to two groups: Group A received GA combined with continuous caudal ropivacaine, while Group B (control) received GA alone. Outcomes assessed included inflammatory biomarkers (interleukin-1β [IL-1β] and IL-6) at 4 h postinduction, Face, Legs, Activity, Cry, and Consolability (FLACC) score, time to initiation of enteral nutrition, and length of hospital stay. Results: Patients in Group A showed significantly lower postoperative increases in serum IL-1β levels (157.26 [281.16] vs. 417.89 [361.55], P = 0.009) and IL-6 levels (6.19 ± 5.43 vs. 12.88 ± 9.85, P = 0.02) compared with Group B. Group A also had significantly lower FLACC pain scores within 24 h ( P < 0.001) and achieved earlier initiation of enteral nutrition (95 [32.5] vs. 120 [177.5] min, P = 0.013) compared with Group B. There was no significant difference in the length of hospital stay between the two groups ( P = 0.786). Conclusions: In this cohort, continuous caudal ropivacaine was associated with an attenuated inflammatory response and improved early postoperative pain control compared with GA alone. While no complications were observed, the small sample size limits our ability to draw definitive conclusions regarding safety.

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