The evaluation of the caudal block performance in 0-8 year-old children using FLACC scale: A retrospective analysis

The evaluation of postoperative pain in pediatrics is a true challenge. We aimed to evaluate the immediate postoperative pain management using FLACC scale after caudal block. The anesthesia records of 0-8 year-old children receiving caudal block under general anesthesia prior to surgery between 1st February-1st August 2020 were evaluated. The intraoperative and postoperative use of opioids were obtained, as well as, the FLACC scale scores. Seventy-eight children out of a total 87 receiving caudal block were included. The patients were evaluated in two groups according to ages of 1-24 (n=37) and 24-96 months (n=41). Intraoperative requirement for opioid was observed in 7.7% (n=6) of patients. Nine patients (11.5%) required fentanyl in the immediate postoperative period with FLACC ≥4. Only 1 patient required opioid both in the intraoperative and immediate postoperative period suggesting a success rate of 98.7%. The patients were observed to receive single dose opioid, despite FLACC scores ≥4 in the following postoperative 1st,2nd and 3rd hours. The subgroups of age were similar in terms of FLACC scores and the changes in these scores within the postoperative 3 hours. There were no urinary retention or motor block recorded. However, paresthesia was recorded in 4 patients at age of 24-96 months, whereas, in none of the patients at age of 1-24 months. The uncomfortable numbness, which could not be described at age of 1-24 months may have caused the difference, as well as, leading to high FLACC scores without any opioid use. Our study supported that the anesthetists consider FLACC scale as a part of pain assessment to administer opioid analgesics, not as a sole indicator. Keywords: Caudal block, pediatric regional anesthesia, FLACC scale, Postoperative pain