Caudal Block Anesthesia Research Articles

What are the factors affecting glanular dehiscence after hypospadias surgery?

BackgroundGlanular dehiscence (GD) is one of the main complications after hypospadias surgery. There is a limited number of publications regarding GD in the literature. ObjectiveThe aim of this work is to reveal the factors that affect GD after a literature review. Evidence acquisitionA literature search for relevant articles was performed in database using the search term glans dehiscence without setting date range limit or any other limits. All articles related to GD after hypospadias surgery were included in this study. After collecting the information from full text articles, 71 articles were included in this systematic review. In these studies, localization of hypospadic meatus, type of surgery, and other clinical data which were thought to behave as risk factors for GD were obtained. Chi-Square test was used to evaluate the differences between the parameters, where p < 0.05 was taken as statistically significant. ResultsAfter evaluating the 71 articles that met the inclusion criteria, 309 cases (3.48%) of GD after 8858 hypospadias repairs were obtained in this review. GD rates were found significantly high for proximal hypospadias (5%), two-stage hypospadia repairs (5%) and re-do hypospadias repair (8.75%) (p = 0.002, 0.022, and 0.004, respectively). Glans width <14 mm, urethral plate (UP) width <7 mm, hypospadias surgeries performed before 6 months of age and after puberty, and caudal block anesthesia increased the rate of GD. ConclusionsThe rate of GD increases after proximal, cripple and staged hypospadias surgeries, a glans width <15 mm and UP width <8 mm, postpubertal surgeries, and caudal anesthesia use during surgery.

The effect of caudal epidural block on the surgical complications of hypospadias repair in children aged 6 to 35 months: A randomized controlled trial

Caudal epidural block (CEB) in hypospadias surgery has the benefit of reducing post-operative pain and possibly intra-operative bleeding. Some studies, however, have suggested that this technique may increase the rate of post-operative complications. Considering the uncertainty about the effect of CEB on surgical complications of hypospadias repair, the current study was performed. The aim of this randomized clinical trial was to compare the complication rates between patients who receive CEB after hypospadias surgery and those who did not. This double-blind randomized controlled trial was conducted on boys aged 6-35 months, who underwent hypospadias repair surgery in a university hospital from March 2018 to March 2019. Sixty patients were randomly divided into two groups (group A: 31 and group B: 29). In group B, CEB was performed, using 0.5mg/kg of 0.125% bupivacaine (Marcaine). Postoperative complications including fistula, meatal stenosis, dehiscence, and occurrence of bleeding were assessed during six months after surgery. The patients were assessed for possible complications at 24h, one week, one, three and six months after surgery. No remarkable differences were observed between the patients in the two groups in terms of the frequency of dehiscence, fistula, and meatal stenosis (P>0.05). Moreover, the difference in complication rates between the patients with proximal and distal hypospadias did not reach statistical significance (P=0.549). Assessment of complications showed no significant difference between the two study groups in terms of dehiscence, fistula, and meatal stenosis (Clavien type III). In addition, complication rate was not significantly different according to severity of hypospadias between the two groups. Our study had limitations such as short follow up and small sample size, which resulted in insignificant difference in complication rate between proximal and distal hypospadias. These limitations request large studies with long term follow up. The current study showed that the use of caudal block anesthesia in comparison with general anesthesia did not increase surgical complications, which approved CEB protocol as a safe method in hypospadias repair.

¿Cuáles son los factores que afectan la dehiscencia del glande tras la cirugía de hipospadias?

BackgroundGlanular dehiscence (GD) is one of the main complications after hypospadias surgery. There is a limited number of publications regarding GD in the literature. ObjectiveThe aim of this work is to reveal the factors that affect GD after a literature review. Evidence acquisitionA literature search for relevant articles was performed in database using the search term glans dehiscence without setting date range limit or any other limits. All articles related to GD after hypospadias surgery were included in this study. After collecting the information from full text articles, 71 articles were included in this systematic review. In these studies, localization of hypospadic meatus, type of surgery, and other clinical data which were thought to behave as risk factors for GD were obtained. Chi-Square test was used to evaluate the differences between the parameters, where p < 0.05 was taken as statistically significant. ResultsAfter evaluating the 71 articles that met the inclusion criteria, 309 cases (3.48%) of GD after 8858 hypospadias repairs were obtained in this review. GD rates were found significantly high for proximal hypospadias (5%), two-stage hypospadia repairs (5%) and re-do hypospadias repair (8.75%) (p = 0.002, 0.022, and 0.004, respectively). Glans width < 14 mm, urethral plate (UP) width < 7 mm, hypospadias surgeries performed before 6 months of age and after puberty, and caudal block anesthesia increased the rate of GD. ConclusionsThe rate of GD increases after proximal, cripple and staged hypospadias surgeries, a glans width < 15 mm and UP width < 8 mm, postpubertal surgeries, and caudal anesthesia use during surgery.

Efficacy of Dexmedetomidine Versus Morphine as an Adjunct to Bupivacaine in Caudal Anesthesia for Pediatric Thoracic Surgeries: A Randomized Controlled Trial.

BackgroundCaudal anesthesia is an effective method of pain management, which can be successfully employed to minimize post-thoracotomy pain in pediatric patients. However, its main disadvantage is the short postoperative analgesic period, which can be prolonged by the concurrent administration of one of many adjuvants.ObjectivesThis prospective randomized, blinded study aimed to compare the efficacy of dexmedetomidine versus morphine as adjuvants to bupivacaine in caudal anesthesia for thoracic surgeries in pediatric patients.MethodsFifty patients were randomly allocated into two equal groups. To achieve caudal epidural block anesthesia, the patients in group M (n = 25) were administered morphine and bupivacaine, while group D (n = 25) received a mixture of dexmedetomidine and bupivacaine. The primary outcome of this study was the postoperative analgesic duration achieved. The secondary outcomes included morphine administration in the first 24 hours following caudal block anesthesia, the face, legs, activity, cry, consolability (FLACC) scale scores, and adverse effects, including vomiting, itching, bradycardia, hypotension, and respiratory depression.ResultsThe results showed that patients who had received dexmedetomidine achieved a longer postoperative analgesia as compared to those who had received morphine (P < 0.001). Postoperatively, the heart rate, blood pressure, pain score, and mean consumption of morphine were lower in group D as compared to the group M. There was no significant difference in the adverse effects between the two groups.ConclusionsThe use of dexmedetomidine as an adjuvant to bupivacaine for caudal anesthesia during pediatric thoracic surgeries induced better and prolonged postoperative analgesia as compared to morphine.

Efficacy and feasibility of day surgery using transurethral seminal vesiculoscopy under caudal block anesthesia for intractable hemospermia.

BackgroundTransurethral seminal vesiculoscopy (TSV) is a safe and effective method for intractable hemospermia. It uses a natural cavity, is fast, involves little trauma, and boasts a low incidence of complications. Because uncontrollable penile erection during general anesthesia will severely influence the surgical operation or even damage the endoscope, spinal anesthesia was applied more on TSV. But spinal anesthesia extends the length of stay in the hospital and brings patients unnecessary discomfort. As the TSV is a quick recovery operation, we should think about a more suitable mode for these patients.MethodsA total of 141 patients received TSV between January 2015 and July 2019: 81 patients received day surgery under caudal block (group A), and 60 received inpatient surgery under spinal anesthesia (group B). Operative time, postoperative hospital stay, hemospermia remission rate, magnetic resonance imaging (MRI) remission rate are compared. Visual analog scale (VAS) scores of groups were taken and compared at 2 time points: when there was pain during surgery (T1) and at the end of surgery (T2). Surgical methods of two groups are the same.ResultsThe mean operative time of two groups are 34 min (group A) and 32 min (group B), and there was no statistical difference. Postoperative hemospermia remission rates are both 100% at 3 months, which at 6 months are 60% and 48%, and there was no statistical difference. MRI remission at 3 months are 72% and 57%, which has no statistical difference. Postoperative complications were mild in two groups like hematuria and dysuria which can relieve within one day, and there were no severe complications. Intraoperative pain was present in 18.5% (15/81) of group A. Their highest VAS score was 3 points, indicating mild pain, which did not influence the surgical process or postoperative recovery. The postoperative VAS scores were similar between the 2 groups. Group A did not require postoperative hospitalization, whereas the average postoperative hospitalization in group B was 2 days.ConclusionsSeminal vesiculoscopy can be performed as a day surgery under caudal block, which has obvious advantages in accelerating postoperative recovery and shortening the hospital stay.

Editorial Comment

No AccessJournal of UrologyHypospadias1 Mar 2017Editorial Comment John S. Wiener John S. WienerJohn S. Wiener More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.08.148AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 197(3 Part 2), pp. 850–851 References 1 : Impact of caudal block on postoperative complications in children undergoing tubularized incised plate urethroplasty for hypospadias repair: a retrospective cohort study. Anesthesia2016; 71: 773. Google Scholar 2 : The effectiveness of pudendal nerve block versus caudal block anesthesia for hypospadias in children. Anesth Analg2013; 117: 1401. Google Scholar © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 197Issue 3 Part 2March 2017Page: 850-851 Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.MetricsAuthor Information John S. Wiener More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of general anaesthesia v/s caudal epidural in paediatric infra umbilical surgeries

Background: Our aim was to compare caudal epidural versus general anaesthesia in paediatric patients for safety, efficacy, post-operative analgesia, cost effectiveness and surgeons comfort.Material and Methods: 60 paediatric patients 2 -6 years of ASA grade I and II posted for infra-umbilical surgery were randomly divided in to two groups. Group C (n=30) received caudal block anaesthesia using 0.25% Ropivacaine 1ml kg -1. Group G (n=30) received general anesthesia with Thiopentone sodium, Succinylscoline as induction agent and O2, N2O, Isoflurane and incremental doses of Atracurium as maintenance. They were extubated in a usual manner after surgery. In both groups pain was assessed by observer pain score.Observation and Results: Cost was less in group C. There was no significant change in hemodynamics in both groups. Duration of rescue analgesia was significant less in group G. Rate of post-operative complication was higher in group G. caudal anaesthesia was much accepted by surgeon.Conclusion: Caudal epidural is quite inexpensive with excellent anaesthesia and satisfactory post-operative analgesia with lesser complication rate.

Clinical effect of sufentanil and levobupivacaine on postoperative analgesia in pediatric caudal block anesthesia

Objective To invetigate the effect and safety of sufentanil mixed levobupivacaine on postoperative analgesia in pediatric caudal block anesthesia.Method Sixty pediatric patients (2 ～ 6 years old) who were undergoing elective abdominal surgery,such as repair hernia of high ligation,were randomly divided into three groups with 20 cases each.after intravenous induction,0.25％ levobupivacaine was injected in sacrum tube in group Ⅰ,0.5 μg/ml sufentanil mixed 0.25％ levobupivacaine and 1.0 μg/ml sufentanil mixed 0.25％ levobupivacaine were injected in sacrum tube in group Ⅱ and group Ⅲ respectively.The analgesia effect,the analgesia time,recover time and adverse reaction were observed and recorded 2,4,8,12,16,24 hours after the surgery.Results The analgesia effect in group Ⅱ、Ⅲ were significantly better than the group Ⅰ when 4、8、12 hours after the operation(P ＜0.05),and the analgesia effect in groupⅢ were significantly better than the group Ⅱ when 8 hours after the operation (P ＜ 0.05).There were no significant differences in three groups when 2、16、24 hours after the operation(P ＞0.05),the analgesia time in group Ⅱ、Ⅲ were significantly longer than the group Ⅰ (P ＜ 0.05),and the analgesia time in group Ⅲ were significantly longer than the group Ⅱ (P ＜ 0.05).There were no differences in the recovery time of three groups (P ＞ 0.05).There were no adverse reactions in three groups.Conclusions 0.5 μg/ml and 1.0 μg/ml sufentanil mixed 0.25％ levobupivacaine may be used on postoperative analgesia in pediatric caudal block anesthesia safely and analgesia effect and time were more better and longer than 0.25％ levobupivacaine singly.The analgesia effect in group with 1.0μg/ml sufentanil mixed 0.25％ levobupivacaine was the best in three groups with the fewest side effects. Key words: Caudal block; Children; Levobupivacaine; Sufentani; Postoperative analgesia

A Successful Aplication of the Caudal Block Anesthesia in Patient with Ankylosing Spondylitis Who Has Severe Kyphoscoliosis

Ankylosing spondylitis (AS), is a chronic, progressive, otoimmune collagen tissue disease characterized by spine, sacroiliac, joint and neighboring tissue inflammation. AS is important for anaesthesiologists due to the problems that can occur during the application of general anesthesia and regional anesthesia. In this paper, we aim to present the caudal block method that we applied to a patient who is planned to have a hemorrhoidectomy operation. We planned to perform a hemorrhoidectomy operation with caudal block method to a 71 year-old patient who was diagnosed as AS 20 years ago. Preoperative evaluation of patients showed that ASA 2, mallompati 2 and neck joint mobility was limited. The caudal block anesthesia is applied to the patient at prone position with 12 cc, 0.5% isobaric bupivacaine. No complications were observed in patients in intraoperative or post-operative period. In conclusion, caudal block method is a convenient approach in anogenital region operations for patients with ankylosing spondylitis.

Urologic daycase surgery: A five year experience

Expectedly, daycase surgery (DCS) is today witnessing a boom in developing countries as a reasonable option in the face of global economic recession, although with limited scope. The aim of this study was to describe the urologic day surgery experience at the Lagos State University Teaching Hospital, Ikeja. All day-case urologic surgeries done between January 2006 and December 2010 were retrospectively studied. Data obtained were patients' personal details, diagnoses, procedures performed, mode of anesthesia, and surgical complications as well as admission rate. A total of 1070 operations were performed. The patients were aged 7 days to 92 years. Local anesthesia was employed in 42.2% while general anesthesia was used in 1.7% of patients, mostly pediatric cases. Caudal block anesthesia (55.8%) was administered for transrectal prostate biopsy and urethrocystoscopic procedures. The diagnostic and therapeutic urologic procedures in adults were mainly prostate biopsy (n = 344, 32.1%), urethrocystoscopy (n = 218, 20.4%), varicocelectomy (n = 143, 13.4%), and orchidectomy (n = 93, 8.7%). Mohan's valvotomy was the most common pediatric operation (n = 19, 1.8%). Postoperative morbidities that warranted hospital admission were observed in 17 (1.6%) cases. Urologic day surgery is feasible with minimal morbidities. The provisions of a dedicated day-case unit or a mobile DCS service may further improve on the volume of cases that can be operated on a day-case basis and has the potential of further reducing the waiting time for surgery.

Day case endourology in surgical outpatient clinic at Ibadan: A 5 year review

To review our day case endourological practice over a five-year period. Data was obtained from the endourology day case register and these were analysed using simple statistical methods. Caudal anaesthesia and intravenous sedatives were used for the procedures. A total of 559 patients underwent endoscopic procedures as day cases. Their ages ranged from 10 to 88 years, with a male to female ratio of 4 to 1. Four hundred and thirty eight (78.4%) were diagnostic and 121 (21.6%) were therapeutic. The main diagnostic procedures were urethrocystoscopy ( n = 222), and cystoscopy alone ( n = 116), cystoscopy and biopsy ( n = 46) while the therapeutic procedures were direct visual internal urethrotomy ( n = 86), endoscopic cystolitholapaxy ( n = 10), and rigid retrograde endoscopic realignment ( n = 7) for posterior urethral injury. The main anaesthesia was caudal block in 472 patients and topical 2% xylocaine jelly with sedation in 86 patients. There is a steady increase in therapeutic day case endourology. Caudal anaesthesia provides effective pain free procedure to the patient. Surgical trainees can benefit by learning the technique of caudal block anaesthesia.

RESEARCH PAPERS / UROLOGICAL ONCOLOGY Caudal block anaesthesia for transrectal biopsy of prostate in patients with anal rectal disorders

RESEARCH PAPERS / UROLOGICAL ONCOLOGY Caudal block anaesthesia for transrectal biopsy of prostate in patients with anal rectal disorders

Plasma concentrations of bupivacaine in young infants after continuous epidural infusion

SummaryThis study reports plasma bupivacaine concentration in seven infants who during major abdominal surgery received lumbar epidural or caudal block anaesthesia. Plasma concentrations (CP) were measured postoperatively after six and twelve h of continuous infusion. Postnatal age ranged from one day to seven months. The local anaesthetic block was performed after induction of anaesthesia. Postoperatively bupivacaine 1.25‐2.5 mg·ml−1 without adrenaline was infused at a rate of 0.5 to 0.83 mg·kg−1·h−1. After six h of infusion the mean value measured was 1.59 μg·ml−1 (range 1.2‐1.94 μg·ml−1). After 12 h the mean value measured was 2.06 μg·ml−1 (range 1.53‐2.98 μg·ml−1). A marked increase in bupivacaine plasma concentration was seen between six and 12 hours of infusion. Bupivacaine plasma concentration never exceeded 4 μg·ml−1. Adverse effects that possibly were due to a toxic reaction to bupivacaine were seen in three patients. In conclusion, the dose administered in this study appears to be high and cannot be recommended as safe dosage in this age group.;