Caudal levobupivacaine–fentanyl achieves stress response attenuation and early extubation in pediatric cardiac surgery

Background Adequate postoperative analgesia coupled with stress response attenuation in children are vital parts of perioperative care. The present study was carried out to evaluate the efficacy of caudal levobupivacaine and fentanyl combination on stress response, postoperative analgesia, and extubation in pediatric cardiac surgery. Patients and methods Fifty patients, ASA II-III, 2–8 years old, undergoing elective cardiac surgical repair were allocated randomly to two groups: group L received 0.125% levobupivacaine at a volume of 1.8 ml/kg; whereas group LF received 0.125% levobupivacaine plus fentanyl 1 μg/kg up to a volume of 1.8 ml/kg. Results Intraoperative fentanyl consumption was significantly low in group LF compared with group L [1.56 ± 0.64 vs. 2.76 ± 0.52 μg/kg in group LF and group L, respectively, 95% confident interval (CI) 0.862–1.538; P 0.001]. Extubation time was significantly shorter in group LF 2.24 ± 0.87 h compared with group L (5.84 ± 1.07 h, 95% CI 2.94 − 4.25; P 0.001). The duration of postoperative analgesia following extubation was significantly longer in group LF 4.56 ± 0.96 h compared with group L (2.21 ± 0.73 h, 95% CI 2.99 − 1.89; P 0.001). The serum cortisol levels were significantly higher in group L than group LF at T2, after sternotomy (21.92 ± 8.39 vs. 13.40 ± 5.48 μg/dl; P 0.001); T3, after termination of cardiopulmonary bypass (32.32 ± 6.82 vs. 20.82 ± 5.85 μg/dl; P 0.001); and T5, at extubation (36.64 ± 9.97 vs. 25.84 ± 9.16 μg/dl; P 0.01). Blood glucose levels increased significantly relative to baseline in both groups, but the increase was significantly lower in group LF compared with group L. Conclusion Caudal levobupivacaine–fentanyl is effective in pediatric cardiac surgery; it attenuates the stress response with concomitant stabilization of hemodynamics. In addition, it provides adequate postoperative analgesia and early extubation.