All medical personnel have a special attitude towards children who come for various surgeries at “Re-Medika”. We want their stay in the hospital to be less stressful, not only for humanitarian reasons, but also for the fact that a traumatized child is much more difficult for any further cooperation, even if it is just a medical examination.” D-r Branko Petrovski, anesthesiologist.

Adequate treatment of postoperative pain is one of the key aspects in the postoperative period. Often difficult communication in terms of pain evaluation can additionally complicate the problem. Pain can be treated with drugs that affect the whole body or with the application of a regional block – in this case a caudal block that will only reduce the pain at the site of surgery. Preoperatively, the anesthesiologist will inform parents about the ways to minimize pain, including the application of caudal block.


It is an application of a local anesthetic (in combination with one or two analgesics) in a so-called caudal epidural space located at the end of the spinal column. In young children, this space is most easily located, where the wide use of this block originated. It is a safe and effective way to provide surgery for as little pain as possible for children undergoing various navel surgery, such as phimosis, inguinal hernia, hypospadias, and others.


The anesthetic blocks the transmission of pain from the site of intervention, and after surgery the child either does not feel pain or is minimal. There is usually no need to add other analgesics during the block. Taking strong analgesics through a vein or mouth can have side effects like itching, nausea and vomiting, difficulty urinating, drowsiness. With caudal block, these side effects are avoided or minimized.


Сите деца, уште додека се на оддел, 45 минути пред интервенцијата примаат седатив во вид на сируп за да дојдат во операционата сала смирени и да не плачат. Вообичаено ги придружува еден од родителите. Воведот во анестезирањето е со маска, а откако детето ќе заспие се става мала канила најчесто во шакатана левата рака. На овој начин детето целосно е поштедено од евентуа- лен стрес при пронаоѓањето на периферна вена, што кај малите деца понекогаш навистина е предизвик. По обезбедувањето на дишење, детето се врти настрана, местото се чисти со антисептички раствор и анестезиологот, по лоцирање на каудалниот простор, со мала игла го става локалниот анестетик. За да трае блокот подолго се става и чепче со аналгетик во анусот. Со овој т.н. мултимодален пристап се обезбедува помала болка и до 14 часа по хируршката интервенција.


Caudal analgesia in children is a technique that has been used for decades with high efficiency and safety. The incidence of side effects is many times lower than when using vein medications, they are transient and disappear with the cessation of the anesthetic effect. Sometimes there is a feeling of weakness in their legs, a feeling of being unable to get wet and sleeping, but they disappear no later than the blocking action.

What we see is a child without pain, playing with their favorite toys or watching a movie. They are often more anxious about not being in their daily surroundings than of surgery itself. Then we know we’ve done the job well.

D-r Branko Petrovski, anesthesiologist

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