Caudal Block Research Articles

Analgesic effect of sacral erector spinae, penile and caudal block after hypospadias surgery: A randomized single blind controlled trial

ABSTRACT Background Hypospadias surgery is associated with acute postoperative pain needing long-term analgesia. Regional anaesthesia is commonly used with general anaesthesia (GA). We aim to compare sacral erector spinae plane block (ESPB) caudal and penile blocks in pain management following hypospadias surgery. Patients and methods This randomized controlled single blind trial was established on 132 pediatric cases aged from 1 to 5 years, American Society of Anesthesiologists (ASA) physical status I-II, planned for hypospadias surgery. Cases were classified into three equal groups; group C: received caudal block (CB) (1 ml/kg bupivacaine 0.25%, maximum 20 ml), group P: received penile block (0.1 ml/kg bupivacaine 0.5%, maximum 2.5 ml) and finally, group E: received ultrasound guided sacral bilateral ESPB (1 mL/kg 0.25% bupivacaine, maximum 20 ml). The blocks were done after GA induction and before the surgical incision. Results Time to 1st rescue analgesia was significantly delayed in groups C and E than group P (P < 0.001) and was insignificantly different between groups C and E. Total pethidine consumption was significantly lower in groups C and E than group P (P = 0.003, and 0.028, respectively). FLACC scores were significantly lower in groups C and E than group P at 4, 6, 8 and 12 h (p < 0.05) and were insignificantly different between groups C and E. Penile engorgement was insignificantly different among the three groups. Conclusion Both ESPB and CB had better pain control and lower opioid consumption compared to penile block, but CB is associated with incidence with penile engorgement and hypotensiveness than other techniques.

A double-blinded randomized control trial to compare the duration of analgesia using morphine, clonidine, or dexmedetomidine as adjuvants to ropivacaine in caudal anesthesia in children undergoing infraumbilical surgeries.

Adjuvants added to the caudal block prolong the duration of analgesia. In a developing country with economic constraints, the choice of an adjuvant will be the medication with a longer duration of analgesia, a favorable side-effect profile, and the least expensive option. We wished to study the duration of postoperative analgesia afforded by three adjuvants: morphine, clonidine, and dexmedetomidine, at doses wherein minimal or nil adverse effects would be attributed to the adjuvant. The primary objective of the current study is to compare the duration of postoperative analgesia with morphine, clonidine, or dexmedetomidine as adjuvants to 0.2% ropivacaine in a for caudal block, in children undergoing elective abdominal, urogenital, and lower limb surgeries. The secondary objectives are (a) to study the total analgesic requirement during the first 24 hours after surgery and (b) to compare the incidence of complications among the three groups. Sixty-three children aged 1-6 years, belonging to American Society of Anesthesia (ASA) physical status I, II, and scheduled to undergo elective infraumbilical surgeries, were enrolled in the study. The children were randomly assigned to one of three groups: Group D received a caudal block with dexmedetomidine 1 μg/kg, Group M received morphine 30 μg/kg, and Group C received clonidine 1.5 μg/kg. All groups also received 0.2% ropivacaine (1-1.25 ml/kg) as part of the caudal block. The duration of analgesia, total analgesic requirements during the first 24 hours after the surgery, and the incidence of complications in the three groups were monitored by a pain nurse who was blinded to the study allocation. The three groups were comparable with respect to age, sex, weight, and duration of surgery. The median time taken for the first rescue analgesic in the dexmedetomidine group was 380 minutes, in the clonidine group was 360 minutes, and in the morphine group was 405 minutes. Though the morphine group had a longer duration of analgesia, it was not statistically significant (P = 0.843). The total perioperative opioids used and side effects were similar among the three groups. There were no episodes of intraoperative bradycardia noted in Groups D, M, and C. However, one patient in Group D required treatment for bradycardia in the postanesthesia care unit. In terms of intraoperative hypotension, 10 patients (43.5%) in Group D, 5 patients (27.8%) in Group C, and 5 patients (22.7%) in Group M required treatment, but this difference was not statistically significant (P = 0.299). There was no significant difference observed in the time to awakening after the anesthesia among the three groups. Postoperative nausea and vomiting were noted in five patients (21.7%) in Group D, one patient (5.6%) in Group C, and four patients (18.2%) in Group M (P = 0.382). One patient in Group M had a sedation score of 5 and required 4 hours of supplemental oxygen via face mask in the ward. Additionally, one patient in Group D reported numbness in both feet lasting 12 hours with spontaneous resolution. While a significant number of patients in all three study groups experienced urinary retention, no patient reported pruritus in the ward. Caudal administration of morphine, dexmedetomidine, and clonidine in children undergoing infraumbilical surgery resulted in an equivalent duration of analgesia.

Caudal Epidural Block versus Combined Ilioinguinal and Iliohypogastric Nerve Block for Post-Operative Analgesia in Pediatric Surgeries Below the Umbilicus

Objective: To compare the duration and effectiveness of postoperative analgesia provided by caudal block versus combined Ilioinguinal and Iliohypogastric nerve block in pediatric infra-umbilical surgeries.Study Design: Quasi-experimental.Place and Duration of Study: The study was carried out at the Anesthesia Department of Pak Emirates Military Hospital (PEMH) Rawalpindi, Pakistan, from June 2021 to December 2021.Materials and Methods: Sample size was calculated from the WHO sample size calculator using the population size received in 6 months. The sample size was filtered down by purposive sampling to 80 (children aged 5-10 years) using a pre-defined inclusion/exclusion criterion scheduled for below umbilicus surgeries. They were alternatively divided into two equal groups (n=40) where Group-C received a caudal block and Group-I received ultrasound-guided Ilioinguinal and Iliohypogastric nerve block. Both groups underwent the same general anesthesia technique with I-gel and similar medications at inductions. Our primary outcome measure was the duration of analgesia using the Revised Faces Pain Scale, where p-value &lt;0.05 was considered significant. The secondary outcomes measured were motor block and urinary retention.Results: Median revised Faces Pain Score (FPS-R) immediately after surgery was 1.50(1) for Group-C and 0.00(1) for Group I, respectively. At 4 hours postoperatively, the median FPS-R in Group-C was 4.00(2), and in Group I, it was 2.00(0). After 8 hours, Group-C had a median FPS-R of 6.50(1) and Group-I had pain scores of 3.00(1). Median pain scores of Group-C and Group-I at 12 hours postoperatively were 8.00(1) and 5.00(1), respectively. The demographic characteristics of the patients were comparable in both groups with similar duration of surgery. Group-C reported some cases of side effects, such as motor block and urinary retention, while Group-I did not have any of these effects. All anesthetic procedures did not otherwise have any adverse events.Conclusion: Our study demonstrated that combined Ilioinguinal and Iliohypogastric nerve block furnished efficient post-operative analgesia while requiring smaller amounts of local anesthetics and avoiding the adverse effects of the caudal block. It is an ideal regional block technique for infra-umbilical surgeries in pediatric populations at busy centres.

Comparison of conventional caudal block, ultrasound guided caudal block and ultrasound guided erector spinae block for pediatric hip surgery: A randomized double blinded study

Comparison of conventional caudal block, ultrasound guided caudal block and ultrasound guided erector spinae block for pediatric hip surgery: A randomized double blinded study

(010) A Novel Collaborative Protocol for Successful Management of PGAD/GPD Mediated by Tarlov Cyst-induced Radiculopathy of Sacral Spinal Nerve Roots in the Cauda Equina

Abstract Introduction In 2012, Komisaruk et al introduced the concept that neurologic-based women’s sexual health issues, genito-pelvic dysesthesia (GPD), could be caused by radiculopathy of sacral spinal nerve roots within the cauda equina. Over the last 4 years, to more effectively manage patients with suspected cauda equina pathology, a robust collaboration among sexual medicine, spine surgery and neurophysiology disciplines has been established. Objectives The aim of this study is to review the collaborative experience in managing patients with genito-pelvic dysesthesia. Methods We defined GPD in the broadest sense to include both unwanted, unrelenting, distressing arousal, pain and/or itching symptoms &amp;gt;6 mo (hyperfunction), and also persistent degrees of genital anesthesia leading to orgasmic dysfunction &amp;gt;6 mo (hypofunction). Charts from 2015 to 2019 of GPD patients presenting to our sexual medicine facility where neurogenital testing results were consistent with radiculopathy of sacral spinal nerve roots within the cauda equina were reviewed retrospectively. Lumbar and sacral MRIs were obtained and reviewed simultaneously in collaborative bi-monthly meetings and identified as having or not having treatable spinal abnormalities, subdivided into subtle or obvious. When appropriate, a transforaminal epidural spinal injection (TFESI) or caudal block with anesthetic agent and/or steroid was administered and the outcome measured by Patient Global Impression of Improvement (PGI-I). Those with clinically significant symptom reduction were considered for minimally invasive spine surgery (MISS). Results 734 patients (586 women; 80%; mean age 47 +/− 24) met criteria for this retrospective chart review. 637 lumbar and/or sacral MRIs were reviewed. A total of 112 TFESI were performed, 90 of which showed positive responses with more than 60% improvement on PGI-I of 1,2. 57 surgeries were performed. 17 patients (71% women) with PGAD underwent MISS for herniated nucleus pulposus and or annular tear. 76% declared post-op clinical improvement with PGI-I 1,2,3 with mean follow-up of 12 months (4 - 30 months). Conclusions Cauda equina pathology can cause unwanted, unrelenting, distressing neurologic-based GPD from radiculopathy of sacral spinal nerve roots. In selected cases these GPDs may be reversed by MISS. There are management benefits from collaboration among sexual medicine, spine surgery and neurophysiology specialists. Disclosure No.

EEG response to a high volume (1.5 mL/kg) caudal block in infants less than 3 months

IntroductionThe substantial compression of the dural sac and the subsequent cranial shift of cerebrospinal fluid caused by a high-volume caudal block has been shown to significantly but transiently reduce cerebral...

A case of successful comprehensive treatment of necrotizing enterocolitis in a newborn child

Necrotizing enterocolitis is an inflammatory disease caused by infection and hypoxic–ischemic damage of the intestinal mucosa, which leads to generalization with the development of a systemic inflammatory response. The pathogenetic mechanisms leading to intestinal wall damage are ischemia and pain. Therefore, the use of central neuraxial blocks, which provide the analgesic effect and preganglionic blockade of the sympathetic nervous system, is pathogenetically justified.&#x0D; The aim of the work is to acquaint practitioners with the case of successful comprehensive treatment using neuraxial blocks in a newborn with necrotizing enterocolitis.&#x0D; Materials and methods. The child was treated at the Department of Anesthesiology and Intensive Care for Newborns of Zaporizhzhia City Pediatric Hospital No. 5. He underwent clinical and biochemical blood tests, microbiological, radiological and ultrasound examinations using hospital equipment.&#x0D; Results. A child was operated due to suspected intestinal perforation and pneumoperitoneum. It was found that throughout the small and large intestines had multiple hemorrhages and air bubbles in the subserosa, but no perforation sites were found. Subsequently, the child underwent conservative treatment with antibacterial therapy according to the de-escalation principle, antifungal therapy, intravenous immunoglobulins, total parenteral nutrition. In addition to this standard treatment, the child underwent caudal-epidural blocks twice a day for a week in the postoperative period for effective analgesia, improvement of microcirculation and splanchnic blood flow.&#x0D; Conclusions. Surgical intervention performed on a newborn child with the second stage of necrotizing enterocolitis (intestinal pneumatosis), when its perforation could not be excluded, did not significantly affect the course of the disease, so the positive outcome can be considered the result of successful comprehensive intensive care. In our opinion, the decisive factor that influenced the positive treatment outcomes (prevention of perforation and peritonitis) was the effect of neuraxial caudal epidural blocks, which contributed to the improvement of microcirculation in the splanchnic area, elimination of intestinal ischemia and effective anesthesia.

Perioperative Analgesic Modality and Effectiveness in Paediatric Patients Who Have Undergone Common Major Urology Surgery - A Two-Year Retrospective Study

Perioperative paediatric major urology surgery pain management remains challenging. These surgeries require general anaesthesia (GA) combined with either regional analgesia technique or systemic morphine infusion for optimal pain relief. We aimed to compare and evaluate the effectiveness of both analgesic techniques. This single centre retrospective descriptive study involved 88 patients, aged 3 months to 12 years old with American Society of Anaesthesiologists (ASA) I or II status, who underwent major urology surgery under GA. Group A patients received perioperative systemic morphine while Group B received regional anaesthesia blocks (continuous caudal epidural infusion, single-shot caudal blocks or single-shot erector spinae blocks). We measured requirements of perioperative rescue intravenous (IV) fentanyl, pain scores using Face, Leg, Activity, Cry, Consolability (FLACC) scale, perioperative non-opioid IV analgesia usage and associated complications. Intraoperative rescue fentanyl in both groups was comparable. Intraoperative non-opioid analgesia and postoperative rescue fentanyl requirement were significantly higher in Group A compared to Group B (p&lt;0.001). Median FLACC scores in Group A were higher than Group B (p&lt;0.001) for first 12 hours post-surgery. Commonest complications in Group A was vomiting (38.6%) and peri-catheter leak in Group B (6.81%). Regional anaesthesia technique is superior to systemic morphine in providing analgesia in the first 12 hours post paediatric major urology surgery and is devoid of opioid side effects.

The Efficacy of Caudal Anesthesia in Pediatric Surgery

Background: Despite a long history of safety, spinal anesthesia (SA) is still seldom used outside of specialist pediatric institutions and is sometimes debated as a primary anesthetic approach for children. To lessen the risk of postoperative apnea, it is often used on previously preterm newborns who have not yet reached viability (60 weeks post- conception) (GA). There is, however, a wealth of evidence indicating its safety and effectiveness for appropriate operations in adolescents. Objective: The primary purpose of this investigation is to assess the efficacy of Caudal anesthesia pediatric surgery. Method: Tertiary care hospital was the setting for this prospective investigation. 200 children, ages 4 to 10, were included in the research because they were all given different types of anesthesia for infraumbilical or lower extremities surgery during the study's 1-year time frame. The research participants had a thorough preoperative assessment. During the study 50 patients of each were given different anesthesia including Endotracheal intubation, LMA, Caudal block and local anesthesia. Results: Majority was belonged to 4-6 years age group, 70% and 60% were male. Plus, majority of the patients were undergone circumcision, 35% and Herniorrhaphy, 28%. Followed by 20% undergone appendectomy and 5% undergone hypospadias repair. Besides, anesthesia induction and recovery on the operating room table, was lowest in the local anesthesia group (P = 0.015), whereas the results were comparable in the other groups. However, patients with caudal and local anesthesia spent significantly less time in the postoperative recovery unit (P &lt; 0.001). In fact, patients who got Caudal block had less complication where only 1% had Convulsions, Bloody puncture and vomiting. Conclusion: Caudal anesthesia as a sole method for pediatric subumbilical surgery is a relatively safe method. Patients having operation under caudal anesthesia have faster discharge times from postoperative recovery units, compared with general anesthesia. This probably reduces recovery unit expenditures.

COMPARISON OF DEXMEDETOMIDINE AND CLONIDINE AS ADDITIVE WHEN GIVEN SEPARATELY, PREMIXED WITH 0.25% ROPIVACAINE IN PEDIATRIC CAUDAL BLOCK, ON INTRA OPERATIVE ANESTHETIC/ ANALGESIC DRUG REQUIREMENT AND DURATION OF POST OPERATIVE ANALGESIA IN HYPOSPADIAS REPAIR SURGERIES

Aim:Comparison of dexmedetomidine and clonidine as additive when given separately, premixed with 0.25% ropivacaine in pediatric caudal block,on intra operative anesthetic/ analgesic drug requirement and duration of post operative analgesia in hypospadias repair surgeries. Methods and Materials:Children,whose parents or guardians,were willing to give consent and fulfilled inclusion criteria were selected for the study.Thepatients were randomly allocated, by double blinding into two groups. Group RD received 0.25% ropivacaine 1 ml/kg +2µg/kg dexmedetomidine (in 0.5 ml volume).Group RC received 1 ml/kg of 0.25% ropivacaine + 1 µg/kg of clonidine (in 0.5 ml volume). Results:Mean age of patients receiving dexmedetomidine and clonidine was 3.20±1.821 and 4.47±1.727 years respectively. No significant difference was obtained in terms of mean age.Blood pressure,Heart rate and Saturation was maintained by both dexmedetomidine and clonidine similarly as revealed by the insignificant p value of &gt;0.05 across the time points during hypospadias repair surgeries.Requirement of adjuvant analgesics intraoperativery and post operative complicationsand was found to be similar in both the groups as revealed by the insignificant P value of 0.309. Time for rescue analgesic postoperatively (min) was significantly (p&lt;0.001) longer among patients receiving dexmedetomidine (706.73±107.428) than clonidine (504.33±97.573). Conclusion:We observed that a single caudal injection of dexmedetomidine (2µg/kg) added to ropivacaine 0.25% offers an advantage over a similar injection of clonidine (1µg/kg) added to ropivacaine 0.25% for postoperative pain relief in children undergoing hypospadias repair surgeries without increase in post operative complications.

Caudal block vs. transversus abdominis plane block for pediatric surgery: a systematic review and meta-analysis.

The caudal block and transversus abdominis plane block (TAP) are commonly used in combination with general anesthesia for pediatric lower abdominal, inguinal, and genitourinary surgeries. There is limited data directly comparing the impact of these techniques on recovery. In this meta-analysis, we compare the duration of postoperative analgesia between these two techniques. This review examined the duration of analgesia in pediatric patients (age 0-18 years) undergoing surgery who received caudal or TAP block after induction of general anesthesia. The primary outcome was duration of analgesia, defined as the time to first rescue analgesic dose. Secondary outcomes included number of rescue analgesic doses, acetaminophen usage within 24 h postoperatively, 24 h pain score area under the curve, and postoperative nausea and vomiting. We systematically searched Pubmed, Central, EMBASE, CINAHL, Google Scholar, Web of Science citation index, the US clinical trials register, and abstracts from prominent 2020-2022 anesthesia conferences for randomized controlled trials that compared these blocks and reported analgesia duration. Twelve RCTs inclusive of 825 patients were identified. TAP block was associated with longer analgesia duration (Mean difference = 1.76 h, 95% CI: 0.70-2.81, p = 0.001) and reduced doses of rescue analgesic within 24 h (Mean difference = 0.50 doses, 95% CI: 0.02-0.98, p = 0.04). No statistically significant differences were detected in other outcomes. This meta-analysis suggests that TAP block provides greater duration of analgesia than caudal block after pediatric surgeries. TAP block was also associated with fewer rescue analgesic doses in the first 24 h without increased pain scores. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=380876, identifier: CRD42022380876.

Comparison of the incidence of intravascular injection using the Tuohy and Quincke needles during ultrasound-guided caudal epidural block: a prospective randomized controlled study

IntroductionIntravascular injection of a local anesthetic can lead to life-threatening complications, such as deficits in neurological function after caudal epidural block. This study aimed to determine whether the intravascular injection...

A COMPARISON OF MAGNESIUM SULPHATE AND DEXAMETHASONE AS AN ADJUVANT TO CAUDAL LEVOBUPIVACAINE FOR POSTOPERATIVE ANALGESIA IN PAEDIATRIC INFRA UMBILICAL SURGERIES.

BACKGROUND: Caudal Anaesthesia is commonly performed anaesthetic technique in paediatric patients undergoing various infra-umbilical surgeries. Prolongation of caudal analgesia using single shot technique can be achieved by addition of various adjuvants. To compare efcacy of post operative analgesia of Magne AIM: sium sulphate and Dexamethasone with Levobupivacaine in caudal anaesthesia. This was randomised double blinded cont METHOD: rolled study conducted on 60 paediatric patients of age group 1-6 year and ASA I-II grade, undergoing infraumbilical surgeries, divided randomly into 2 groups. Group M (n= 30) received 50mg Inj. Magnesium sulphate with Inj. Levobupivacaine 0.25% (1ml/kg) and Group D (n= 30) received 0.1mg/kg Inj. Dexamethasone with Inj. Levobupivacaine 0.25% (1ml/kg) in caudal block after induction with general anaesthesia. Duration of analgesia, intraoperative cardiovascular stability and adverse effects were assessed. Duration of post operative analgesia and time of rst rescue analgesia requirement was assessed using FLACC score (FLACC score&gt;\=4). Standard qualitative and quantitative tests were used to analyse and compare the results. P&lt;0.05 considered as statistically signicant. The mean duration of analgesia was s RESULTS: ignicantly longer in group D than group M with p&lt; 0.001. No signicant hemodynamic changes and side effects were observed in both groups. Dexa CONCLUSION: methasone 0.1mg/kg and Magnesium sulphate 50mg as an adjuvant to 0.25% Levobupivacaine in caudal Anaesthesia are safe and Dexamethasone as adjuvant to Caudal Levobupivacaine provides prolonged analgesia than Magnesium sulphate.

CAUDAL BLOCK AS A TREATMENT MODALITY TO AVOID LUMBAR SPINE SURGERY IN PATIENTS WITH CHRONIC BACK PAIN

Introduction: Chronic Lower back pain is the most common cause of functional disability in an adult due to prolonged sitting, ageing society, obesity &amp; sedentary lifestyle, the number of Chronic Lower back pain patients can be expected to increase in the coming decades. Caudal Pain Block is one of the procedures to avoid lumbar spine surgery in patients with chronic low back pain. Main aim of this study is to analyse weather the effect of caudal pain block can avoid lumbar spinal surgery in patients with chronic low back pain. Aims And Objectives: To find out that weather the effect of caudal pain block can avoid lumbar spinal surgery in patients with chronic low back pain.To review the literature. Material and Methods: A prospective study was done on 55 patients with chronic low back pain who were given caudal pain block and followed up at 1,2, 3, and 6 months and outcomes measured using visual analogue scale and The Roland–Morris Disability Questionnaire. Observations: Caudal pain block was given in 55 patients, 51 patients got relieved of their pain and were able to avoid spine surgery and 4 out of 55 patients went for the spine surgery despite given caudal pain block. Results:According to VAS score 12 patients had excellent results, 21 had good results, 18 had fair and 4 had poor results. According to Roland–Morris Disability Questionnaire - 10 patients had excellent results, 20 patients had good results, 21 had fair results and 4 had poor results. Conclusion:Chronic low back pain managed with Caudal pain block is a good treatment modality with excellent results and good alternative to avoid operative procedures.

Comparison of Ultrasound Guided with Conventional Landmark Technique Caudal Block in Pediatric Patients Scheduled for Lower Abdomen Surgery under General Anesthesia: A Prospective Randomized Study

Background: Perioperative pain in pediatric population is a special concern and Caudal block is easy to perform extensively safe if used in children, resulting in low pain scores and when combined with general anaesthesia, it reduces the requirement for volatile agents, opioids, improved postoperative analgesia, and earlier extubation. Ultrasound guided caudal block has reduced the complication rates such as inadvertent dural or vascular puncture. Aim of the study was to compare the success rate of ultrasound guided with conventional landmark technique caudal block in pediatric patients undergoing lower abdominal surgery under general anaesthesia.&#x0D; Methods: Hundred pediatric patients, ASA class I, age between 6 months to 7 years of either sex, posted for lower abdomen surgery under general anaesthesia were randomly divided in to two groups. In group C- The group with caudal block using conventional landmark technique was used and Group U- The group with caudal block using ultrasound technique was used. Primary objectives of the study to find out the success rate of block in both the groups.&#x0D; Results: The demographic data were comparable in group C and group U. Significant difference was seen in the distribution of successful block between group C and group U. (p value 0.008) block was successful in 96% of patients in group U which was significantly higher as compared to group C (76%). significant difference was seen in the distribution of number of attempts between group C and group U. (p value 0.001).&#x0D; Conclusion: We conclude that Caudal block by ultrasound technique increases the first puncture success rate, decreases the number of multiple needle puncture attempts and overall success rate when compared to the conventional landmark technique in pediatric patients undergoing lower abdomen surgery.

Caudal block in combination with general anesthesia as the best method of anesthesia for large joint replacement

Operations of total hip and knee arthroplasty are currently one of the most frequent surgical interventions performed for functional rehabilitation of patients with osteoarthritis or patients who have received a fracture of the femoral neck. The best method for providing anesthesia and pain relief for total joint replacement has not been determined. Until now, a unified point of view on the choice of the optimal method of anesthesia and analgesia in surgical interventions for arthroplasty has not been formed. Purpose of the study.: To study the effectiveness of caudal anesthesia in hip and knee arthroplasty. Material and research methods: The study was conducted in the surgical clinic of the AMU in 56 patients who underwent surgery for hip and knee arthroplasty. The age of the patients varied from 57 to 99 years. Depending on the chosen anesthesia technique, the patients were divided into 2 groups: in the 1st group (n=28) endotracheal anesthesia was performed, induction of anesthesia with propofol and rocuronium bromide, anesthesia based on sevoflurane 1.0 vol% with caudal administration of ropivacaine 2 mg/kg in combinations with dexamethasone 0.2 mg/kg; group 2 (n=28 patients) underwent multicomponent endotracheal anesthesia (propofol 3 mg/kg, rocuronium bromide 0.6 mg/kg, sevoflurane 1.5–2.5 vol/% with high doses of fentanyl 5–6 µg /kg/hour. Research results: During the traumatic moment of the operation, the average heart rate in group I (general anesthesia + caudal block) was significantly lower than in group II (general anesthesia) (69.4±2.0 versus 89.40±3.0, p=0.010), but there are significant differences in SBP or DBP between the two groups. Conclusion: The inclusion of caudal blockade in the protocol of general anesthesia provides adequate pain relief, both intra- and postoperatively, in patients undergoing arthroplasty of large joints of the lower extremities.

The Outcomes of Caudal or Intravenous Addition of Morphine and Clonidine into The Caudal Block Performed with Levobupivacaine In Children; A Retrospective Study

Ineffective post-operative pain management in children may be associated with chronic pain. 98 pediatric patients aged 6 months to 12 years who underwent caudal levobupivacaine for hypospadias surgery were evaluated retrospectively. The patients who received additional intravenous clonidine were added in group 1; the patients who received additional intravenous morphine were added in group 2, patients who received additional caudal clonidine was added in group 3, and patients who received additional caudal morphine was added in group 4. CHEOPS score was assessed 1, 6, 12 and 24 hours after the operation and patients with score 6 or higher were determined. At the 1st hour, there were 8 cases in the intravenous morphine group (40%), 5cases in the intravenous clonidine group (25%), and 3 cases in the caudal morphine group (15%). At the 12th hour, there were 5 cases in the intravenous morphine group (25%), 10 cases in the intravenous clonidine group (50%), and 4 cases in the caudal morphine group (20%). At the 24th hour, there were 10 cases in the intravenous morphine group (50%), 10 cases in the intravenous clonidine group (50%), 9 cases in the caudal morphine group (45%) and 2 cases in the caudal clonidine group (10%) (p&amp;lt;0.05). There was no difference between the groups in terms of sedation scores at all hours (p&amp;gt;0.05). The lowest pain scores at the 1st, 12th, and 24th hours were recorded in the caudal clonidine group. It had the lowest pain scores at 6 hours. By these methods, in favor of the clonidine group, we agreed that the analgesia lasts for approximately 12 hours postoperatively, so the postoperative stress that the children and their families have can be minimized.

Safety and efficacy of esketamine for postoperative analgesia in pediatric patients with hypospadias.

To explore the safety and efficacy of the combination of continuous intravenous infusion of esketamine with sacral block for postoperative analgesia in pediatric patients undergoing surgery for hypospadias. Pediatric patients (n = 77) undergoing surgery for hypospadias were randomized into two groups: a hydromorphone group (H group, initial dose, 0.02 mg/kg; maintenance dose, 0.01 mg/kg/h) or an esketamine group (E group, initial dose, 0.3 mg/kg; maintenance dose 0.15 mg/kg/h). Caudal epidural block involved injection of 0.2% ropivacaine 1 ml/kg through the sacral hiatus. Age, weight, grade of hypospadias, intraoperative blood loss, operative time, and awaking time of patients were recorded. The Face, Legs, Activity, Cry and Consolability (FLACC) scale and Ramsay sedation scores were recorded when leaving the PACU (0 h) and at postoperative 2, 6, 12, 24, 36, and 48 h. The Pediatric Anesthesia Emergence Delirium Scale (PAED), incidence of hypotension, respiratory depression, nausea and vomiting and pruritus, and the time to first bowel movement after surgery were recorded. There were no significant differences in demographic and clinical characteristics between the H group and the E group. There were no significant differences in FLACC scores at postoperative 0, 2, 6, 12, 24, 36, and 48 h in intra-group and inter-group comparisons. There were no significant differences in Ramsay sedation scores at postoperative 0, 2, 6, 12, 24, 36, and 48 h in the intra-group comparisons. Ramsay sedation scores were significantly lower at postoperative 2, 12, and 36 h in the H group compared to the E group. There were no significant differences in the PAED scale or incidence of nausea and vomiting or pruritus between the H group and the E group. The incidence of hypotension and respiratory depression was significantly lower, and the time to first bowel movement was significantly shorter in the E group compared to the H group. Urinary tryptophan, 5-hydroxytryptamine and substance P levels were significantly lower but arginine was significantly higher in the E group compared to the H group. The combination of continuous intravenous infusion of esketamine with sacral block provided safe and effective postoperative analgesia for pediatric patients undergoing surgery for hypospadias. Chinese Clinical Trial Register ChiCTR2200066967. Clinical trial registry URL: http://www.chictr.org.cn/edit.aspx?pid=185042&htm=4.

Comparative Study between Caudal Epidural Block and Ultrasound Guided Transversus Abdominis Plane Block for Post-Operative Analgesia in Children Undergoing Infraumblical Surgeries

Comparative Study between Caudal Epidural Block and Ultrasound Guided Transversus Abdominis Plane Block for Post-Operative Analgesia in Children Undergoing Infraumblical Surgeries

Ultrasound-guided Techniques for Perioperative Analgesia in Pediatric Lower Abdominal Surgeries: Quadratus Lumborum Block with Bupivacaine versus Caudal Bupivacaine and Neostigmine

BACKGROUND: Ultrasound-guided regional anesthesia techniques for perioperative analgesia in pediatric patients scheduled for lower abdominal surgeries can be achieved either by quadratus lumborum block (QLB) or caudal block (CB). Neostigmine was co-administered with caudal bupivacaine to shorten the onset and extend the duration of analgesia. OBJECTIVES: This study aimed to compare between 2 ultrasound-guided techniques used for perioperative analgesia (QLB with bupivacaine vs. CB with bupivacaine/neostigmine) regarding the total amount of rescue analgesic (acetaminophen mg/kg) used for pain relief at 24 hours postsurgery in pediatric patients undergoing lower abdominal surgeries in a developing country and to discuss existing barriers during the implementation of both techniques. STUDY DESIGN: A randomized, double-blind, prospective, single-center study. SETTING: Ain-Shams University Hospitals METHODS: Eighty pediatric patients scheduled for lower abdominal surgeries under general anesthesia were randomly allocated to receive either ultrasound-guided QLB using bupivacaine or ultrasound-guided CB using a bupivacaine/neostigmine mixture. The total amount of rescue analgesic (acetaminophen mg/kg) 24 hours postsurgery was considered as the primary outcome while the time to first rescue analgesia, pain score, postoperative nausea and vomiting, bradycardia, hypotension, and urinary retention were considered as secondary outcomes. RESULTS: In the QLB group, the time to first rescue analgesia was longer whereas the total analgesic dose (mg/kg) was lower than the CB group (P &lt; 0.001, P = 0.007, respectively). While, on the other hand, in CB group, the time to perform the block was shorter and Parents Satisfaction Score 24 h postsurgery was lower than the QLB group (P &lt; 0.001, P &lt; 0.001, respectively). Side effects were infrequent and comparable between the study groups. LIMITATIONS: First, the researchers did not assess the dermatomal level before or after the operation in either group. Second, the investigators should have noticed the first voiding time to demonstrate accurately the incidence of urine retention. Third, a cost-effectiveness analysis of perioperative costs (drugs, staff, resources being used) of these regional anesthesia techniques when applied in an ambulatory setting should have been done, which would be helpful for those in resource-limited settings. CONCLUSIONS: Postoperative analgesia for pediatric patients undergoing lower abdominal surgeries can be safely and effectively achieved by QLB with bupivacaine and a CB with a bupivacaine/neostigmine mixture with priority given to CB, especially in resource-limited settings. KEY WORDS: Quadratus lumborum, caudal, bupivacaine, neostigmine, ultrasound, pediatric, postoperative, pain